{"reporting_entity_name":"Healthfirst Insurance Company","reporting_entity_type":"Health Insurance Issuer","last_updated_on":"2026-06-24","version":"2.0.0","provider_references":[{"provider_group_id":1,"network_name":["Healthfirst Qualified Health Plan"],"provider_groups":[{"npi":[1000000000],"tin":{"type":"npi","value":"1000000000"}}]}],"in_network":[{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35131","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, iliac artery (common, hypogastric, external)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1213.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15834","name":"Exc excessive skin hip","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":573.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96411","name":"Chemo iv push addl drug","description":"Chemotherapy administration; intravenous, push technique, each additional substance/drug (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64714","name":"Revise low back nerve(s)","description":"Neuroplasty, major peripheral nerve, arm or leg, open; lumbar plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":617.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88356","name":"Analysis nerve","description":"Morphometric analysis; nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28307","name":"Incision of metatarsal","description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal with autograft (other than first toe)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71048","name":"X-ray exam chest 4+ views","description":"Radiologic examination, chest; 4 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76830","name":"Transvaginal us non-ob","description":"Ultrasound, transvaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01830","name":"Anes arthr/ndsc wrst/hnd nos","description":"Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4626","name":"Tracheostomy cleaning brush","description":"Tracheostomy cleaning brush, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L2860","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78814","name":"Pet image w/ct lmtd","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1218.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57170","name":"Fitting of diaphragm/cap","description":"Diaphragm or cervical cap fitting with instructions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3253","name":"Shoe molded plastazote cust","description":"Foot, molded shoe plastazote (or similar) custom fitted, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44360","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99449","name":"Ntrprof ph1/ntrnet/ehr 31/>","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patients treating/requesting physician or other qualified health care profess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42509","name":"Parotid duct diversion","description":"Parotid duct diversion, bilateral (wilke type procedure); with excision of both submandibular glands","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82040","name":"Assay of serum albumin","description":"Albumin; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86717","name":"Leishmania antibody","description":"Antibody; leishmania","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26478","name":"Lengthening of hand tendon","description":"Lengthening of tendon, flexor, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58542","name":"Lsh w/t/o ut 250 g or less","description":"Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27814","name":"Treatment of ankle fracture","description":"Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":644.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41140","name":"Removal of tongue","description":"Glossectomy; complete or total, with or without tracheostomy, without radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35702","name":"Expl n/flwd surg uxtr art","description":"Exploration not followed by surgical repair, artery; upper extremity (eg, axillary, brachial, radial, ulnar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27479","name":"Surgery to stop leg growth","description":"Arrest, epiphyseal, any method (eg, epiphysiodesis); combined distal femur, proximal tibia and fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":777.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93313","name":"Echo transesophageal","description":"Echocardiography, transesophageal, real-time with image documentation (2d) (with or without m-mode recording); placement of transesophageal probe only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44403","name":"Colonoscopy w/resection","description":"Colonoscopy through stoma; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43510","name":"Surgical opening of stomach","description":"Gastrotomy; with esophageal dilation and insertion of permanent intraluminal tube (eg, celestin or mousseaux-barbin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45100","name":"Biopsy of rectum","description":"Biopsy of anorectal wall, anal approach (eg, congenital megacolon)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79445","name":"Nuclear rx intra-arterial","description":"Radiopharmaceutical therapy, by intra-arterial particulate administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54304","name":"Revision of penis","description":"Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":605.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74263","name":"Ct colonography screening","description":"Computed tomographic (ct) colonography, screening, including image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0112","name":"Potassium hydroxide preps","description":"All potassium hydroxide (koh) preparations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45820","name":"Repair rectourethral fistula","description":"Closure of rectourethral fistula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1062.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11043","name":"Dbrdmt musc&/fsca 1st 20/<","description":"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25075","name":"Exc forearm les sc < 3 cm","description":"Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93590","name":"Perq transcath cls mitral","description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33025","name":"Incision of heart sac","description":"Creation of pericardial window or partial resection for drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0158","name":"Walker leg extenders set of4","description":"Leg extensions for walker, per set of four (4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27430","name":"Revision of thigh muscles","description":"Quadricepsplasty (eg, bennett or thompson type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33500","name":"Repair heart vessel fistula","description":"Repair of coronary arteriovenous or arteriocardiac chamber fistula; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87210","name":"Smear wet mount saline/ink","description":"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, india ink, koh preps)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54505","name":"Biopsy of testis","description":"Biopsy of testis, incisional (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46260","name":"Remove in/ex hem groups 2+","description":"Hemorrhoidectomy, internal and external, 2 or more columns/groups;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85396","name":"Clotting assay whole blood","description":"Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47802","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1279.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27827","name":"Treat lower leg fracture","description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35045","name":"Repair defect of arm artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, radial or ulnar artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61108","name":"Tdh pnxr evac&/drg sdrl hmta","description":"Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for evacuation and/or drainage of subdural hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0118","name":"Glaucoma scrn hgh risk direc","description":"Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41530","name":"Tongue base vol reduction","description":"Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20932","name":"Osteoart algrft w/surf & b1","description":"Allograft, includes templating, cutting, placement and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42410","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21230","name":"Rib cartilage graft","description":"Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27750","name":"Treatment of tibia fracture","description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15782","name":"Dermabrasion other than face","description":"Dermabrasion; regional, other than face","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66680","name":"Repair iris & ciliary body","description":"Repair of iris, ciliary body (as for iridodialysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53450","name":"Revision of urethra","description":"Urethromeatoplasty, with mucosal advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27602","name":"Decompression of lower leg","description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32442","name":"Sleeve pneumonectomy","description":"Removal of lung, pneumonectomy; with resection of segment of trachea followed by broncho-tracheal anastomosis (sleeve pneumonectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2461.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31297","name":"Nsl/sins ndsc surg sphn sins","description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1396.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54160","name":"Circumcision neonate","description":"Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58263","name":"Vag hyst w/t/o & vag repair","description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69405","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":206.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33820","name":"Repair pda by ligation","description":"Repair of patent ductus arteriosus; by ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":838.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6404","name":"Sterile gauze > 48 sq in","description":"Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74177","name":"Ct abd & pelvis w/contrast","description":"Computed tomography, abdomen and pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92326","name":"Replacement of contact lens","description":"Replacement of contact lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24666","name":"Optx radial head/nck fx rplc","description":"Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; with radial head prosthetic replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33946","name":"Ecmo/ecls initiation venous","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; initiation, veno-venous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59001","name":"Amniocentesis therapeutic","description":"Amniocentesis; therapeutic amniotic fluid reduction (includes ultrasound guidance)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75970","name":"Vascular biopsy","description":"Transcatheter biopsy, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":447.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83605","name":"Assay of lactic acid","description":"Lactate (lactic acid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52277","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with resection of external sphincter (sphincterotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":259.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28264","name":"Release of midfoot joint","description":"Capsulotomy, midtarsal (eg, heyman type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":848.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21925","name":"Biopsy soft tissue of back","description":"Biopsy, soft tissue of back or flank; deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49436","name":"Embedded ip cath exit-site","description":"Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2203","name":"Frame depth less than 22 in","description":"Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82154","name":"Androstanediol glucuronide","description":"Androstanediol glucuronide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37220","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1449.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69540","name":"Excision aural polyp","description":"Excision aural polyp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22862","name":"Rev rplcm rthrp 1ntrspc lmbr","description":"Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37253","name":"Intrvasc us noncoronary addl","description":"Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95936","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2580","name":"Pelvic control pelvic sling","description":"Addition to lower extremity, pelvic control, pelvic sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4055","name":"Replace non-molded calf lace","description":"Replace non-molded calf lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87652","name":"Strep a dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); streptococcus, group a, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31000","name":"Irrigation maxillary sinus","description":"Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61340","name":"Subtemporal cranial dcmprn","description":"Subtemporal cranial decompression (pseudotumor cerebri, slit ventricle syndrome)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1314.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74363","name":"X-ray bile duct dilation","description":"Percutaneous transhepatic dilation of biliary duct stricture with or without placement of stent, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":216.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65850","name":"Trabeculotomy ab externo","description":"Trabeculotomy ab externo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":506.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43332","name":"Transab esoph hiat hern rpr","description":"Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L0430","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":692.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33984","name":"Ecmo/ecls rmvl prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), open, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47801","name":"Placement bile duct support","description":"Placement of choledochal stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":932.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4765","name":"Dialysate conc pow per pack","description":"Dialysate concentrate, powder, additive for peritoneal dialysis, per packet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62281","name":"Treat spinal cord lesion","description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83593","name":"Fractionation ketosteroids","description":"Ketosteroids, 17- (17-ks); fractionation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83625","name":"Assay of ldh enzymes","description":"Lactate dehydrogenase (ld), (ldh); isoenzymes, separation and quantitation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11752","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35563","name":"Art byp grft ilioiliac","description":"Bypass graft, with vein; ilioiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43410","name":"Repair esophagus wound","description":"Suture of esophageal wound or injury; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7520","name":"Repair prosthesis per 15 min","description":"Repair prosthetic device, labor component, per 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6711","name":"Ped term dev, hook, vol open","description":"Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":327.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5785","name":"Exoskeletal bk ultralt mater","description":"Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0985","name":"W/c seat lift mechanism","description":"Wheelchair accessory, seat lift mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83718","name":"Assay of lipoprotein","description":"Lipoprotein, direct measurement; high density cholesterol (hdl cholesterol)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17110","name":"Destruction b9 les up to 14","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35623","name":"Bpg axillary-pop/-tibial","description":"Bypass graft, with other than vein; axillary-popliteal or -tibial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52441","name":"Cysto insj trnsprstc 1 implt","description":"Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1099.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93306","name":"Tte w/doppler complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69610","name":"Tympanic membrane repair","description":"Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5673","name":"Socket insert w lock mech","description":"Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23900","name":"Interthoracoscplr amputation","description":"Interthoracoscapular amputation (forequarter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1175.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01462","name":"Anes clsd px lower l/a/f","description":"Anesthesia for all closed procedures on lower leg, ankle, and foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75961","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":349.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31645","name":"Brnchsc w/ther aspir 1st","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0572","name":"Aerosol compressor adjust pr","description":"Aerosol compressor, adjustable pressure, light duty for intermittent use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2374","name":"Hand/chin ctrl std joystick","description":"Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95044","name":"Patch/application tests","description":"Patch or application test(s) (specify number of tests)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4590","name":"Special casting material","description":"Special casting material (e.g., fiberglass)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49595","name":"Rpr aa hrn 1st > 10 rdc","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":615.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95903","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5930","name":"High activity knee frame","description":"Addition, endoskeletal system, high activity knee control frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1672.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88341","name":"Imhchem/imcytchm ea add antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6709","name":"Term dev mech hand vol close","description":"Terminal device, hand, mechanical, voluntary closing, any material, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78227","name":"Hepatobil syst image w/drug","description":"Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93241","name":"Xtrnl ecg rec>48hr<7d","description":"External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1812","name":"Knee ext/flex w act res ctrl","description":"Dynamic knee, extension/flexion device with active resistance control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP08","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52315","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95940","name":"Ionm in operatng room 15 min","description":"Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80305","name":"Drug test prsmv dir opt obs","description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28455","name":"Tx tarsal b1 fx w/mnpj each","description":"Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90467","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26550","name":"Pollicization digit","description":"Pollicization of a digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15276","name":"Skin sub graft f/n/hf/g addl","description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81187","name":"Cnbp gene detc abnor allele","description":"Cnbp (cchc-type zinc finger nucleic acid binding protein) (eg, myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80417","name":"Renin stimulation panel","description":"Peripheral vein renin stimulation panel (eg, captopril) this panel must include the following: renin (84244 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21812","name":"Treatment of rib fracture","description":"Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 4-6 ribs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":628.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61313","name":"Crnec/crnot sttl icere","description":"Craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4157","name":"Ef special metabolic inherit","description":"Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0252","name":"Pet imaging initial dx","description":"Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97028","name":"Ultraviolet therapy","description":"Application of a modality to 1 or more areas; ultraviolet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84181","name":"Western blot test","description":"Protein; western blot, with interpretation and report, blood or other body fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27250","name":"Treat hip dislocation","description":"Closed treatment of hip dislocation, traumatic; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87498","name":"Enterovirus probe&revrs trns","description":"Infectious agent detection by nucleic acid (dna or rna); enterovirus, amplified probe technique, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4406","name":"Pectin based ostomy paste","description":"Ostomy skin barrier, pectin-based, paste, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0992","name":"Wheelchair solid seat insert","description":"Manual wheelchair accessory, solid seat insert","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7032","name":"Replacement nasal cushion","description":"Cushion for use on nasal mask interface, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84110","name":"Assay of porphobilinogen","description":"Porphobilinogen, urine; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27823","name":"Treatment of ankle fracture","description":"Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":822.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0075T","name":"Perq stent/chest vert art","description":"Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":877.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0056","name":"Seat ht <17 or >=21 ltwt wc","description":"Seat height less than 17 or equal to or greater than 21 for a high strength, lightweight, or ultralightweight wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54700","name":"I&d epdidyms tstis&/scrot sp","description":"Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28636","name":"Treat toe dislocation","description":"Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":256.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76810","name":"Ob us >/= 14 wks addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71060","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22610","name":"Arthrd pst tq 1ntrspc thrc","description":"Arthrodesis, posterior or posterolateral technique, single interspace; thoracic (with lateral transverse technique, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25170","name":"Resect radius/ulnar tumor","description":"Radical resection of tumor, radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1249.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33404","name":"Prepare heart-aorta conduit","description":"Construction of apical-aortic conduit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1517.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76881","name":"Us compl joint r-t w/img","description":"Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50760","name":"Ureteroureterostomy","description":"Ureteroureterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":936.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58550","name":"Laparo-asst vag hysterectomy","description":"Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86756","name":"Respiratory virus antibody","description":"Antibody; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28310","name":"Revision of big toe","description":"Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":443.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47701","name":"Bile duct revision","description":"Portoenterostomy (eg, kasai procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP09","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43215","name":"Esophagoscopy flex remove fb","description":"Esophagoscopy, flexible, transoral; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52281","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27618","name":"Exc leg/ankle tum < 3 cm","description":"Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15277","name":"Skn sub grft f/n/hf/g child","description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29897","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85366","name":"Fibrinogen test","description":"Fibrin(ogen) degradation (split) products (fdp) (fsp); paracoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27558","name":"Treat knee dislocation","description":"Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair, with augmentation/reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6262","name":"Wound filler dry form / gram","description":"Wound filler, dry form, per gram, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5840","name":"Multi-axial knee/shin system","description":"Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1759.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95251","name":"Cont gluc mntr analysis i&r","description":"Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76706","name":"Us abdl aorta screen aaa","description":"Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (aaa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67225","name":"Eye photodynamic ther add-on","description":"Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy, second eye, at single session (list separately in addition to code for primary eye treatment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73218","name":"Mri upper extremity w/o dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99491","name":"Chrnc care mgmt phys 1st 30","description":"Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or funct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35636","name":"Bpg splenorenal","description":"Bypass graft, with other than vein; splenorenal (splenic to renal arterial anastomosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1409.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63251","name":"Revise spinal cord vsls thrc","description":"Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2801.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99473","name":"Self-meas bp pt educaj/train","description":"Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23334","name":"Shoulder prosthesis removal","description":"Removal of prosthesis, includes debridement and synovectomy when performed; humeral or glenoid component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":899.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88367","name":"Insitu hybridization auto","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31505","name":"Diagnostic laryngoscopy","description":"Laryngoscopy, indirect; diagnostic (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2201","name":"Man w/ch acc seat w>=20in<24in","description":"Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50860","name":"Transplant ureter to skin","description":"Ureterostomy, transplantation of ureter to skin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":765.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36571","name":"Insert picvad cath","description":"Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1062.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92315","name":"C-lens fitg tech aphakia 1","description":"Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, 1 eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0217T","name":"Njx paravert w/us lumb/sac","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3762","name":"Eo rigid w/o joints pre ots","description":"Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21137","name":"Rdctj forehead cntrg only","description":"Reduction forehead; contouring only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":629.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25337","name":"Reconstruct ulna/radioulnar","description":"Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53275","name":"Repair of urethra defect","description":"Excision or fulguration; urethral prolapse","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49421","name":"Ins tun ip cath for dial opn","description":"Insertion of tunneled intraperitoneal catheter for dialysis, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50081","name":"Perq nl/pl lithotrp cplx>2cm","description":"Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; complex (eg, stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, co","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0202","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80435","name":"Insulin tolerance panel","description":"Insulin tolerance panel; for growth hormone deficiency this panel must include the following: glucose (82947 x 5) human growth hormone (hgh) (83003 x 5)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90833","name":"Psytx w pt w e/m 30 min","description":"Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43336","name":"Thorabd diaphr hern repair","description":"Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1202.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2624","name":"Polishing artifical eye","description":"Polishing/resurfacing of ocular prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49496","name":"Rpr ing hernia baby blocked","description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93926","name":"Lower extremity study","description":"Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25119","name":"Partial removal of ulna","description":"Synovectomy, extensor tendon sheath, wrist, single compartment; with resection of distal ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":413.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67921","name":"Repair eyelid defect","description":"Repair of entropion; suture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75945","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57106","name":"Vagnc prtl rmvl vag wall","description":"Vaginectomy, partial removal of vaginal wall;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69801","name":"Incise inner ear","description":"Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38770","name":"Remove pelvis lymph nodes","description":"Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86645","name":"Cmv antibody igm","description":"Antibody; cytomegalovirus (cmv), igm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29220","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44213","name":"Lap mobil splenic fl add-on","description":"Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19112","name":"Excise breast duct fistula","description":"Excision of lactiferous duct fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33927","name":"Impltj tot rplcmt hrt sys","description":"Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2232.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11983","name":"Remove/insert drug implant","description":"Removal with reinsertion, non-biodegradable drug delivery implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65265","name":"Remove foreign body from eye","description":"Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0858","name":"Pwc gp3 hd sing pow opt s/b","description":"Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22847","name":"Insert spine fixation device","description":"Anterior instrumentation; 8 or more vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":690.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65105","name":"Remove eye/attach implant","description":"Enucleation of eye; with implant, muscles attached to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85475","name":"Hemolysin acid","description":"Hemolysin, acid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74330","name":"X-ray bile/panc endoscopy","description":"Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78580","name":"Lung perfusion imaging","description":"Pulmonary perfusion imaging (eg, particulate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6248","name":"Hydrogel drsg gel filler","description":"Hydrogel dressing, wound filler, gel, per fluid ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88314","name":"Histochemical stains add-on","description":"Special stain including interpretation and report; histochemical stain on frozen tissue block (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0315","name":"Counsel immune <21  5-15 m","description":"Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 5-15 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57510","name":"Cauterization of cervix","description":"Cautery of cervix; electro or thermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71551","name":"Mri chest w/dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27742","name":"Repair of leg epiphyses","description":"Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula; and distal femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":656.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33962","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, 6 years and older (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73718","name":"Mri lower extremity w/o dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48155","name":"Removal of pancreas","description":"Pancreatectomy, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12036","name":"Intmd rpr s/a/t/ext 20.1-30","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30430","name":"Revision of nose","description":"Rhinoplasty, secondary; minor revision (small amount of nasal tip work)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42215","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate; major revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50390","name":"Drainage of kidney lesion","description":"Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0488","name":"Tlso rigid lined pre one pie","description":"Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts g","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":488.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37221","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1960.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2550","name":"Thigh/wght bear high roll cu","description":"Addition to lower extremity, thigh/weight bearing, high roll cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86609","name":"Bacterium antibody","description":"Antibody; bacterium, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99454","name":"Rem mntr physiol param 16-30","description":"Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 16-30 days in a 30-day period","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25246","name":"Injection for wrist x-ray","description":"Injection procedure for wrist arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31380","name":"Partial removal of larynx","description":"Partial laryngectomy (hemilaryngectomy); anterovertical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3702","name":"Eo w/o joints cf","description":"Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00100","name":"Anes px salivary gland w/bx","description":"Anesthesia for procedures on salivary glands, including biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76981","name":"Use parenchyma","description":"Ultrasound, elastography; parenchyma (eg, organ)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44393","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":376.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28193","name":"Removal of foot foreign body","description":"Removal of foreign body, foot; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":426.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61470","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1577.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90968","name":"Esrd svc pr day pt 2-11","description":"End-stage renal disease (esrd) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0238T","name":"Trluml perip athrc iliac art","description":"Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93303","name":"Echo transthoracic","description":"Transthoracic echocardiography for congenital cardiac anomalies; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93650","name":"Icar cath abltj av node func","description":"Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72157","name":"Mri chest spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59612","name":"Vbac delivery only","description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":818.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62325","name":"Njx interlaminar crv/thrc","description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thorac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2013","name":"Post-d/c h vst ext pt 75 m","description":"Extensive (75 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient fa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55680","name":"Remove sperm pouch lesion","description":"Excision of mullerian duct cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20690","name":"Appl unipln uni ext fixj sys","description":"Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":502.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22556","name":"Arthrd ant ntrbd min dsc thc","description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6204","name":"Composite drsg >16<=48 sq in","description":"Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00548","name":"Anes thrcm px trach&bronchi","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); intrathoracic procedures on the trachea and bronchi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33255","name":"Ablate atria w/o bypass ext","description":"Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61619","name":"Repair dura","description":"Secondary repair of dura for cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by local or regionalized vascularized pedicle flap or myocutaneous flap (including galea, temporalis, frontalis or occipitalis muscle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21310","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87324","name":"Clostridium ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; clostridium difficile toxin(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27030","name":"Arthrotomy hip w/drainage","description":"Arthrotomy, hip, with drainage (eg, infection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":794.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2251","name":"Brief chkin, 5-10, non-e/m","description":"Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87502","name":"Influenza dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33226","name":"Reposition l ventric lead","description":"Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70557","name":"Mri brain w/o dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":512.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0601","name":"Cont airway pressure device","description":"Continuous positive airway pressure (cpap) device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55175","name":"Revision of scrotum","description":"Scrotoplasty; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86215","name":"Deoxyribonuclease antibody","description":"Deoxyribonuclease, antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28531","name":"Treat sesamoid bone fracture","description":"Open treatment of sesamoid fracture, with or without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":272.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86711","name":"John cunningham antibody","description":"Antibody; jc (john cunningham) virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2391","name":"Solid caster tire","description":"Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70170","name":"X-ray exam of tear duct","description":"Dacryocystography, nasolacrimal duct, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53444","name":"Insert tandem cuff","description":"Insertion of tandem cuff (dual cuff)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45300","name":"Proctosigmoidoscopy dx","description":"Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6224","name":"Gauze > 48 in no w/sal w/o b","description":"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7030","name":"Cpap full face mask","description":"Full face mask used with positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27097","name":"Revision of hip tendon","description":"Release or recession, hamstring, proximal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23485","name":"Revision of collar bone","description":"Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5676","name":"Bk knee joints single axis p","description":"Additions to lower extremity, below knee, knee joints, single axis, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43286","name":"Esphg tot w/laps moblj","description":"Esophagectomy, total or near total, with laparoscopic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, laparoscopic transhiatal esophagectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2627.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71270","name":"Ct thorax dx c-/c+","description":"Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55706","name":"Bx prst8 ndl sat sampling","description":"Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74181","name":"Mri abdomen w/o contrast","description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23575","name":"Cltx scap fx w/mnpj +-tractj","description":"Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27601","name":"Decompression of lower leg","description":"Decompression fasciotomy, leg; posterior compartment(s) only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85530","name":"Heparin-protamine tolerance","description":"Heparin-protamine tolerance test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90809","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5420","name":"Postop dsg & 1 cast chg ak/d","description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change ak or knee disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":754.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95909","name":"Nrv cndj tst 5-6 studies","description":"Nerve conduction studies; 5-6 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92652","name":"Aep thrshld est mlt freq i&r","description":"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25101","name":"Explore/treat wrist joint","description":"Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":337.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59076","name":"Fetal shunt placement w/us","description":"Fetal shunt placement, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":467.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0503","name":"Battery pneum vad replacemnt","description":"Battery for pneumatic ventricular assist device, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":633.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35903","name":"Excision graft extremity","description":"Excision of infected graft; extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50955","name":"Ureter endoscopy & biopsy","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33514","name":"Cabg vein five","description":"Coronary artery bypass, vein only; 5 coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99422","name":"Ol dig e/m svc 11-20 min","description":"Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46947","name":"Hemorrhoidopexy by stapling","description":"Hemorrhoidopexy (eg, for prolapsing internal hemorrhoids) by stapling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95024","name":"Iq tests w/allergenic xtrcs","description":"Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88331","name":"Path consltj surg 1 blk 1spc","description":"Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76942","name":"Echo guide for biopsy","description":"Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31295","name":"Nsl/sins ndsc surg max sins","description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82042","name":"Other source albumin quan ea","description":"Albumin; other source, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33391","name":"Valvuloplasty aortic valve","description":"Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex (eg, leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1995.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15845","name":"Skin and muscle repair face","description":"Graft for facial nerve paralysis; regional muscle transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1818","name":"Sps/pass forearm device","description":"Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27658","name":"Repair of leg tendon each","description":"Repair, flexor tendon, leg; primary, without graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":302.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76813","name":"Ob us nuchal meas 1 gest","description":"Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82106","name":"Alpha-fetoprotein amniotic","description":"Alpha-fetoprotein (afp); amniotic fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83002","name":"Assay of gonadotropin (lh)","description":"Gonadotropin; luteinizing hormone (lh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92265","name":"Ndl oculoelectromyography 1+","description":"Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5653","name":"Knee disart expand wall sock","description":"Addition to lower extremity, knee disarticulation, expandable wall socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32856","name":"Prepare donor lung double","description":"Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70355","name":"Panoramic x-ray of jaws","description":"Orthopantogram (eg, panoramic x-ray)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26121","name":"Release palm contracture","description":"Fasciectomy, palm only, with or without z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21180","name":"Rcnstj forehead w/autograft","description":"Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1433.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23195","name":"Resection humeral head","description":"Resection, humeral head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":629.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38571","name":"Laparoscopy lymphadenectomy","description":"Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":415.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0105","name":"Colorectal scrn; hi risk ind","description":"Colorectal cancer screening; colonoscopy on individual at high risk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15839","name":"Exc excessive skn other area","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5718","name":"Knee-shin exo frct swg & sta","description":"Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27403","name":"Repair of knee cartilage","description":"Arthrotomy with meniscus repair, knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":542.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3977","name":"Sewhfo cap desgn w/jnt(s) cf","description":"Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":833.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4366","name":"Ostomy vent","description":"Ostomy vent, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77261","name":"Ther radiology tx plng smpl","description":"Therapeutic radiology treatment planning; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82247","name":"Bilirubin total","description":"Bilirubin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77403","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99443","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74160","name":"Ct abdomen w/contrast","description":"Computed tomography, abdomen; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6687","name":"Frame typ socket bel elbow/w","description":"Upper extremity addition, frame type socket, below elbow or wrist disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88334","name":"Path consltj surg cyto xm ea","description":"Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14000","name":"Tis trnfr trunk 10 sq cm/<","description":"Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":394.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33978","name":"Remove ventricular device","description":"Removal of ventricular assist device; extracorporeal, biventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1157.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92353","name":"Fit aphakia spectcl multifoc","description":"Fitting of spectacle prosthesis for aphakia; multifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15630","name":"Delay flap eye/nos/ear/lip","description":"Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63195","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1401.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23530","name":"Optx strnclav dislc aqt/chrn","description":"Open treatment of sternoclavicular dislocation, acute or chronic;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15941","name":"Exc isch pr ulc prm sut ostc","description":"Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35509","name":"Art byp grft contral carotid","description":"Bypass graft, with vein; carotid-contralateral carotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1249.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0244","name":"Toilet seat raised","description":"Raised toilet seat","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24575","name":"Optx humeral epcndylr fx","description":"Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0004","name":"High strength ltwt whlchr","description":"High strength, lightweight wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99205","name":"Office o/p new hi 60 min","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P7001","name":"Culture bacterial urine","description":"Culture, bacterial, urine; quantitative, sensitivity study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68761","name":"Close tear duct opening","description":"Closure of the lacrimal punctum; by plug, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00560","name":"Anes px heart w/o pump oxtj","description":"Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51600","name":"Injection for bladder x-ray","description":"Injection procedure for cystography or voiding urethrocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33880","name":"Evasc rpr ta ndgft cov lsa","description":"Endovascular repair of thoracic aorta, including pre-procedure sizing and device selection, nonselective catheterization(s), all associated radiological supervision and interpretation; by deployment of an aorto-aortic tube endograft covering the left subclavian artery and all aortic tube endograft e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1568.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77011","name":"Ct scan for localization","description":"Computed tomography guidance for stereotactic localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95028","name":"Iq tsts allergy delayed rxn","description":"Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81413","name":"Car ion chnnlpath inc 10 gns","description":"Cardiac ion channelopathies (eg, brugada syndrome, long qt syndrome, short qt syndrome, catecholaminergic polymorphic ventricular tachycardia); genomic sequence analysis panel, must include sequencing of at least 10 genes, including ank2, casq2, cav3, kcne1, kcne2, kcnh2, kcnj2, kcnq1, ryr2, and scn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60545","name":"Explore adrenal gland","description":"Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1054.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33536","name":"Cabg arterial four or more","description":"Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2297.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80076","name":"Hepatic function panel","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 amino (ast) (sgot) (84450)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11421","name":"Exc h-f-nk-sp b9+marg 0.6-1","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57210","name":"Repair vagina/perineum","description":"Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27656","name":"Repair leg fascia defect","description":"Repair, fascial defect of leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27500","name":"Treatment of thigh fracture","description":"Closed treatment of femoral shaft fracture, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17110","name":"Destruction b9 les up to 14","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25915","name":"Amputation of forearm","description":"Krukenberg procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":990.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78130","name":"Red cell survival study","description":"Red cell survival study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00756","name":"Anes hrna rpr diphrg hrna","description":"Anesthesia for hernia repairs in upper abdomen; transabdominal repair of diaphragmatic hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83528","name":"Assay of intrinsic factor","description":"Intrinsic factor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L6025","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3897.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51575","name":"Removal of bladder & nodes","description":"Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1476.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84060","name":"Assay acid phosphatase","description":"Phosphatase, acid; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41006","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, deep, supramylohyoid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2730","name":"Special base curve","description":"Special base curve, glass or plastic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82044","name":"Ur albumin semiquantitative","description":"Albumin; urine (eg, microalbumin), semiquantitative (eg, reagent strip assay)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26496","name":"Revise thumb tendon","description":"Opponensplasty; other methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29730","name":"Windowing of cast","description":"Windowing of cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82044","name":"Ur albumin semiquantitative","description":"Albumin; urine (eg, microalbumin), semiquantitative (eg, reagent strip assay)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95782","name":"Polysom <6 yrs 4/> paramtrs","description":"Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86753","name":"Protozoa antibody nos","description":"Antibody; protozoa, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81164","name":"Brca1&2 gen ful dup/del alys","description":"Brca1 (brca1, dna repair associated), brca2 (brca2, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0446","name":"Intens behave ther cardio dx","description":"Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86332","name":"Immune complex assay","description":"Immune complex assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99418","name":"Prolng ip/obs e/m ea 15 min","description":"Prolonged inpatient or observation evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (list separately in addition to the cod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27358","name":"Remove femur lesion/fixation","description":"Excision or curettage of bone cyst or benign tumor of femur; with internal fixation (list in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93356","name":"Myocrd strain img spckl trck","description":"Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (list separately in addition to codes for echocardiography imaging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36820","name":"Av fusion/forearm vein","description":"Arteriovenous anastomosis, open; by forearm vein transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20251","name":"Biopsy vrt bdy open lmbr/crv","description":"Biopsy, vertebral body, open; lumbar or cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29889","name":"Arthrs aid pcl rpr/agmntj","description":"Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1034.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88311","name":"Decalcify tissue","description":"Decalcification procedure (list separately in addition to code for surgical pathology examination)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0806","name":"Pov group 2 std up to 300lbs","description":"Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57510","name":"Cauterization of cervix","description":"Cautery of cervix; electro or thermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0468T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97116","name":"Gait training therapy","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82030","name":"Assay of adp & amp","description":"Adenosine, 5-monophosphate, cyclic (cyclic amp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95905","name":"Motor &/ sens nrve cndj test","description":"Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes f-wave study when performed, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24605","name":"Tx clsd elbow dislc req anes","description":"Treatment of closed elbow dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":396.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76830","name":"Transvaginal us non-ob","description":"Ultrasound, transvaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0621","name":"Patient lift sling or seat","description":"Sling or seat, patient lift, canvas or nylon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54410","name":"Remove/replace penis prosth","description":"Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":696.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37244","name":"Vasc embolize/occlude bleed","description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3506.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31050","name":"Exploration sphenoid sinus","description":"Sinusotomy, sphenoid, with or without biopsy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2327","name":"Head control interface mech","description":"Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR","","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8622","name":"Repl alkaline battery","description":"Alkaline battery for use with cochlear implant device, any size, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73722","name":"Mri joint of lwr extr w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5690","name":"Bk waist belt padded and lin","description":"Addition to lower extremity, below knee, waist belt, padded and lined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35642","name":"Bpg carotid-vertebral","description":"Bypass graft, with other than vein; carotid-vertebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42821","name":"Remove tonsils and adenoids","description":"Tonsillectomy and adenoidectomy; age 12 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61533","name":"Implant brain electrodes","description":"Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term seizure monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1394.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52010","name":"Cystoscopy & duct catheter","description":"Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct radiography, exclusive of radiologic service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82696","name":"Assay of etiocholanolone","description":"Etiocholanolone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43351","name":"Surgical opening esophagus","description":"Esophagostomy, fistulization of esophagus, external; thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1086.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2210","name":"Lens sphcy bifocal 4.25-7/ov","description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57330","name":"Repair bladder-vagina lesion","description":"Closure of vesicovaginal fistula; transvesical and vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80408","name":"Aldosterone suppression eval","description":"Aldosterone suppression evaluation panel (eg, saline infusion) this panel must include the following: aldosterone (82088 x 2) renin (84244 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19105","name":"Cryosurg ablate fa each","description":"Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86060","name":"Antistreptolysin o titer","description":"Antistreptolysin 0; titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35616","name":"Bpg subclavian-axillary","description":"Bypass graft, with other than vein; subclavian-axillary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22857","name":"Tot disc arthrp 1ntrspc lmbr","description":"Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1505.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96574","name":"Dbrdmt prmlg les w/pdt","description":"Debridement of premalignant hyperkeratotic lesion(s) (ie, targeted curettage, abrasion) followed with photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":196.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27497","name":"Decompression of thigh/knee","description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15221","name":"Fth/gft fr s/a/l each addl","description":"Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57100","name":"Biopsy vaginal mucosa simple","description":"Biopsy of vaginal mucosa; simple (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49180","name":"Biopsy abdominal mass","description":"Biopsy, abdominal or retroperitoneal mass, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58674","name":"Laps abltj uterine fibroids","description":"Laparoscopy, surgical, ablation of uterine fibroid(s) including intraoperative ultrasound guidance and monitoring, radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45330","name":"Diagnostic sigmoidoscopy","description":"Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37243","name":"Vasc embolize/occlude organ","description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3927","name":"Fo pip dip no jt spr pre ots","description":"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1845","name":"Ko double upright pre cst","description":"Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a sp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3470","name":"Shoe heel thomas extend to b","description":"Heel, thomas extended to ball","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27513","name":"Treatment of thigh fracture","description":"Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35132","name":"Repair artery rupture groin","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, iliac artery (common, hypogastric, external)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1444.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2615","name":"Pos back post/lat wdth <22in","description":"Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87800","name":"Detect agnt mult dna direc","description":"Infectious agent detection by nucleic acid (dna or rna), multiple organisms; direct probe(s) technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3906","name":"Who w/o joints cf","description":"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48548","name":"Fuse pancreas and bowel","description":"Pancreaticojejunostomy, side-to-side anastomosis (puestow-type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55110","name":"Explore scrotum","description":"Scrotal exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55876","name":"Place rt device/marker pros","description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96125","name":"Cognitive test by hc pro","description":"Standardized cognitive performance testing (eg, ross information processing assessment) per hour of a qualified health care professionals time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26991","name":"Drainage of pelvis bursa","description":"Incision and drainage, pelvis or hip joint area; infected bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":594.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5600","name":"Hip disart sach laminat mold","description":"Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2440.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42894","name":"Revision of pharyngeal walls","description":"Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67334","name":"Revise eye muscle w/suture","description":"Strabismus surgery by posterior fixation suture technique, with or without muscle recession (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93505","name":"Endomyocardial biopsy","description":"Endomyocardial biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6684","name":"Test socket shldr disart/tho","description":"Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":221.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31505","name":"Diagnostic laryngoscopy","description":"Laryngoscopy, indirect; diagnostic (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5982","name":"Exoskeletal axial rotation u","description":"All exoskeletal lower extremity prostheses, axial rotation unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36460","name":"Intrauterine transfusion ftl","description":"Transfusion, intrauterine, fetal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31645","name":"Brnchsc w/ther aspir 1st","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44126","name":"Enterectomy w/o taper cong","description":"Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; without tapering","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2076.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55705","name":"Bx prst8 any approach nonimg","description":"Biopsy, prostate, any approach, nonimaging-guided","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22222","name":"Osteot dsc ant 1vrt sgm thrc","description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1581.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45327","name":"Proctosigmoidoscopy w/stent","description":"Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6915","name":"Hand restoration replacmnt g","description":"Hand restoration (shading, and measurements included), replacement glove for above","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11106","name":"Incal bx skn single les","description":"Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19290","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01832","name":"Anes arthr/ndsc tot wrst rpl","description":"Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; total wrist replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99453","name":"Rem mntr physiol param setup","description":"Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); initial set-up and patient education on use of equipment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72120","name":"X-ray bend only l-s spine","description":"Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0186","name":"Air pressure mattress","description":"Air pressure mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15847","name":"Exc skin abd add-on","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99408","name":"Audit/dast 15-30 min","description":"Alcohol and/or substance (other than tobacco) abuse structured screening (eg, audit, dast), and brief intervention (sbi) services; 15 to 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26350","name":"Repair finger/hand tendon","description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no mans land); primary or secondary without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":600.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87425","name":"Rotavirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; rotavirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36566","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; with subcutaneous port(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3774.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60240","name":"Removal of thyroid","description":"Thyroidectomy, total or complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61600","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1801.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35601","name":"Bpg com crtd-ipsi int crtd","description":"Bypass graft, with other than vein; common carotid-ipsilateral internal carotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93892","name":"Tcd emboli detect w/o inj","description":"Transcranial doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98942","name":"Chiropractic manj 5 regions","description":"Chiropractic manipulative treatment (cmt); spinal, 5 regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51102","name":"Drain bl w/cath insertion","description":"Aspiration of bladder; with insertion of suprapubic catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64487","name":"Tap block uni by infusion","description":"Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) unilateral; by continuous infusion(s) (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1893","name":"Intro/sheath, fixed,non-peel","description":"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45000","name":"Drainage of pelvic abscess","description":"Transrectal drainage of pelvic abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":342.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64734","name":"Incision of cheek nerve","description":"Transection or avulsion of; infraorbital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21558","name":"Resect neck tumor 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1145.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26450","name":"Incision of palm tendon","description":"Tenotomy, flexor, palm, open, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67570","name":"Decompress optic nerve","description":"Optic nerve decompression (eg, incision or fenestration of optic nerve sheath)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":785.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4420","name":"Ost pch clsd for bar w lk fl","description":"Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59870","name":"Evacuate mole of uterus","description":"Uterine evacuation and curettage for hydatidiform mole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5510","name":"Prep bk ptb plaster molded","description":"Preparatory, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28124","name":"Partial removal of toe","description":"Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":385.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26555","name":"Positional change of finger","description":"Transfer, finger to another position without microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1155.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4641","name":"Radiopharm dx agent noc","description":"Radiopharmaceutical, diagnostic, not otherwise classified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38745","name":"Remove armpit lymph nodes","description":"Axillary lymphadenectomy; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86777","name":"Toxoplasma antibody","description":"Antibody; toxoplasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99451","name":"Ntrprof ph1/ntrnet/ehr 5/>","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a written report to the patients treating/requesting physician or other qualified health care professional, 5 mi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51992","name":"Laparo sling operation","description":"Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":692.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65765","name":"Keratophakia","description":"Keratophakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66821","name":"After cataract laser surgery","description":"Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, yag laser) (1 or more stages)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":321.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75572","name":"Ct hrt w/3d image","description":"Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3d image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68520","name":"Removal of tear sac","description":"Excision of lacrimal sac (dacryocystectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":427.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27197","name":"Clsd tx pelvic ring fx","description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; without","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1236","name":"Folding ped wc adjustable","description":"Wheelchair, pediatric size, folding, adjustable, with seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92132","name":"Cptrzd oph dx img ant sgm","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), anterior segment, with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5828","name":"Endo knee-shin fluid swg/sta","description":"Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1712.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77075","name":"Radex osseous survey compl","description":"Radiologic examination, osseous survey; complete (axial and appendicular skeleton)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50540","name":"Revision of horseshoe kidney","description":"Symphysiotomy for horseshoe kidney with or without pyeloplasty and/or other plastic procedure, unilateral or bilateral (1 operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92358","name":"Aphakia prosth service temp","description":"Prosthesis service for aphakia, temporary (disposable or loan, including materials)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38102","name":"Removal of spleen total","description":"Splenectomy; total, en bloc for extensive disease, in conjunction with other procedure (list in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33218","name":"Repair lead pace-defib one","description":"Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0241","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95873","name":"Guide nerv destr elec stim","description":"Electrical stimulation for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4330","name":"Stool collection pouch","description":"Perianal fecal collection pouch with adhesive, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0256","name":"Hospital bed var ht w/o matt","description":"Hospital bed, variable height, hi-lo, with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61334","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1159.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82085","name":"Assay of aldolase","description":"Aldolase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5250","name":"Hip canad sing axi cons fric","description":"Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33989","name":"Removal of left heart vent","description":"Removal of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ecmo/ecls","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43773","name":"Lap replace gastr adj device","description":"Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1070.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0109","name":"Diab manage trn ind/group","description":"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93893","name":"Tcd std icr art ven-art shnt","description":"Transcranial doppler study of the intracranial arteries; venous-arterial shunt detection with intravenous microbubble injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75964","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76814","name":"Ob us nuchal meas add-on","description":"Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36460","name":"Intrauterine transfusion ftl","description":"Transfusion, intrauterine, fetal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28730","name":"Fusion of foot bones","description":"Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87390","name":"Hiv-1 ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hiv-1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47370","name":"Laparo ablate liver tumor rf","description":"Laparoscopy, surgical, ablation of 1 or more liver tumor(s); radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5062","name":"Drnble ostomy pouch w/o barr","description":"Ostomy pouch, drainable; without barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15365","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":261.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12015","name":"Rpr f/e/e/n/l/m 7.6-12.5 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21445","name":"Optx mndblr/max alv ridge fx","description":"Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":624.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90828","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4088","name":"Gastro/jejuno tube, low-pro","description":"Gastrostomy/jejunostomy tube, low-profile, any material, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74182","name":"Mri abdomen w/contrast","description":"Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84550","name":"Assay of blood/uric acid","description":"Uric acid; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64788","name":"Remove skin nerve lesion","description":"Excision of neurofibroma or neurolemmoma; cutaneous nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78264","name":"Gastric emptying img study","description":"Gastric emptying imaging study (eg, solid, liquid, or both);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65101","name":"Removal of eye","description":"Enucleation of eye; without implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":480.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5858","name":"Stance phase only","description":"Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9051.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92998","name":"Pul art balloon repr percut","description":"Percutaneous transluminal pulmonary artery balloon angioplasty; each additional vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97140","name":"Manual therapy 1/> regions","description":"Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58825","name":"Transposition ovary(s)","description":"Transposition, ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":452.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10081","name":"I&d pilonidal cyst comp","description":"Incision and drainage of pilonidal cyst; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3090","name":"Arch supp att to shoe long/m","description":"Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35654","name":"Bpg axillary-femoral-femoral","description":"Bypass graft, with other than vein; axillary-femoral-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1206.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52342","name":"Cysto w/up stricture tx","description":"Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16000","name":"Initial treatment of burn(s)","description":"Initial treatment, first degree burn, when no more than local treatment is required","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31649","name":"Bronchial valve remov addl","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78830","name":"Rp loclzj tum spect w/ct 1","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect) with concurrently acquired computed tomography (ct) transmission scan for anatomical review, localizati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53621","name":"Dilate urethra stricture","description":"Dilation of urethral stricture by passage of filiform and follower, male; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50590","name":"Fragmenting of kidney stone","description":"Lithotripsy, extracorporeal shock wave","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":596.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9555","name":"Rb82 rubidium","description":"Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65781","name":"Ocular reconst transplant","description":"Ocular surface reconstruction; limbal stem cell allograft (eg, cadaveric or living donor)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":798.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47383","name":"Perq abltj lvr cryoablation","description":"Ablation, 1 or more liver tumor(s), percutaneous, cryoablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64568","name":"Opn impltj crnl nrv nea&pg","description":"Open implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":544.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0219T","name":"Plmt post facet implt cerv","description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38900","name":"Io map of sent lymph node","description":"Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1806","name":"Sps wrist device","description":"Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82608","name":"B-12 binding capacity","description":"Cyanocobalamin (vitamin b-12); unsaturated binding capacity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57180","name":"Treat vaginal bleeding","description":"Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24358","name":"Repair elbow w/deb open","description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfers elbow); debridement, soft tissue and/or bone, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88367","name":"Insitu hybridization auto","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60520","name":"Removal of thymus gland","description":"Thymectomy, partial or total; transcervical approach (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72202","name":"X-ray exam si joints 3/> vws","description":"Radiologic examination, sacroiliac joints; 3 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27280","name":"Arthr si jt opn b1grf instrm","description":"Arthrodesis, sacroiliac joint, open, includes obtaining bone graft, including instrumentation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1186.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88285","name":"Chromosome count additional","description":"Chromosome analysis; additional cells counted, each study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69436","name":"Create eardrum opening","description":"Tympanostomy (requiring insertion of ventilating tube), general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1392","name":"Portable oxygen concentrator","description":"Portable oxygen concentrator, rental","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78492","name":"Myocrd img pet mlt rst&strs","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6208","name":"Contact layer > 48 sq in","description":"Contact layer, sterile, more than 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35650","name":"Bpg axillary-axillary","description":"Bypass graft, with other than vein; axillary-axillary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61586","name":"Resect nasopharynx skull","description":"Bicoronal, transzygomatic and/or lefort i osteotomy approach to anterior cranial fossa with or without internal fixation, without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2207.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17266","name":"Dstrj mal les t/a/l >4.0 cm","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0416","name":"Prostate biopsy, any mthd","description":"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0422","name":"Intens cardiac rehab w/exerc","description":"Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78104","name":"Bone marrow imaging body","description":"Bone marrow imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55860","name":"Surgical exposure prostate","description":"Exposure of prostate, any approach, for insertion of radioactive substance;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":708.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0464","name":"Tlso 4mod sacro-scap pre","description":"Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, corona","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":722.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21705","name":"Revision of neck muscle/rib","description":"Division of scalenus anticus; with resection of cervical rib","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27656","name":"Repair leg fascia defect","description":"Repair, fascial defect of leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":527.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80178","name":"Assay of lithium","description":"Lithium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33864","name":"Ascending aortic graft","description":"Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (eg, david procedure, yacoub procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28005","name":"Treat foot bone lesion","description":"Incision, bone cortex (eg, osteomyelitis or bone abscess), foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":461.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58145","name":"Myomectomy vag method","description":"Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2203","name":"Lens sphcyl bifocal 4.00d/.1","description":"Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59620","name":"Attempted vbac delivery only","description":"Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93621","name":"Comp ep evl l pac&rec c sins","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1902.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77372","name":"Srs linear based","description":"Radiation treatment delivery, stereotactic radiosurgery (srs), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0665","name":"Pneumatic appliance full arm","description":"Non-segmental pneumatic appliance for use with pneumatic compressor, full arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49440","name":"Place gastrostomy tube perc","description":"Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":719.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3962","name":"Sewho erbs palsey design abd","description":"Shoulder elbow wrist hand orthosis, abduction positioning, erbs palsey design, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":327.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23195","name":"Resection humeral head","description":"Resection, humeral head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88152","name":"Cytopath c/v auto redo","description":"Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2001","name":"Post d/c h vst new pt 20 m","description":"Brief (20 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11057","name":"Parng/cutg b9 hyprkr les >4","description":"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than 4 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42725","name":"I&d absc phrngl xtrnl appr","description":"Incision and drainage abscess; retropharyngeal or parapharyngeal, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":624.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15769","name":"Grfg autol soft tiss dir exc","description":"Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23410","name":"Repair rotator cuff acute","description":"Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":691.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4527","name":"Adult size pull-on lg","description":"Adult sized disposable incontinence product, protective underwear/pull-on, large size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0635","name":"Patient lift electric","description":"Patient lift, electric with seat or sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87190","name":"Sc std myobacteria prop meth","description":"Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9603","name":"One-way allow prorated miles","description":"Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93290","name":"Interrog dev eval icpms ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of 1 or more reco","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5266","name":"Battery for hearing device","description":"Battery for use in hearing device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2627","name":"Scleral cover shell","description":"Scleral cover shell","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44615","name":"Intestinal stricturoplasty","description":"Intestinal stricturoplasty (enterotomy and enterorrhaphy) with or without dilation, for intestinal obstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51570","name":"Removal of bladder","description":"Cystectomy, complete; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38209","name":"Wash harvest stem cells","description":"Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80050","name":"General health panel","description":"General health panel this panel must include the following: comprehensive metabolic panel (80053) 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 (85","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83873","name":"Assay of csf protein","description":"Myelin basic protein, cerebrospinal fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22858","name":"Tot disc arthrp 2nd lvl crv","description":"Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36833","name":"Av fistula revision","description":"Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84127","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4631","name":"Afo, walk boot type, cus fab","description":"Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":875.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37607","name":"Lig/banding angioacs av fstl","description":"Ligation or banding of angioaccess arteriovenous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95708","name":"Eeg wo vid ea 12-26hr unmntr","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, each increment of 12-26 hours; unmonitored","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0958","name":"Whlchr att- conv 1 arm drive","description":"Manual wheelchair accessory, one-arm drive attachment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83582","name":"Assay of ketogenic steroids","description":"Ketogenic steroids, fractionation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29044","name":"Appl bdy cst sho to hip 1thi","description":"Application of body cast, shoulder to hips; including 1 thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87516","name":"Hepatitis b dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis b virus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33952","name":"Ecmo/ecls insj prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":371.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4412","name":"Ost pouch drain high output","description":"Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50432","name":"Plmt nephrostomy catheter","description":"Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":714.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15944","name":"Exc isch pr ulc skn flp clsr","description":"Excision, ischial pressure ulcer, with skin flap closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0071","name":"Fr cstr comp pne tire rep ea","description":"Front caster assembly, complete, with pneumatic tire, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83718","name":"Assay of lipoprotein","description":"Lipoprotein, direct measurement; high density cholesterol (hdl cholesterol)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88120","name":"Cytp urne 3-5 probes ea spec","description":"Cytopathology, in situ hybridization (eg, fish), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67912","name":"Correction eyelid w/implant","description":"Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83670","name":"Assay of lap enzyme","description":"Leucine aminopeptidase (lap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27884","name":"Amputation follow-up surgery","description":"Amputation, leg, through tibia and fibula; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":492.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61526","name":"Removal of brain lesion","description":"Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2950.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6695","name":"Elbow socket ins use w/o lck","description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84156","name":"Assay of protein urine","description":"Protein, total, except by refractometry; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64415","name":"Njx aa&/strd brch plxs img","description":"Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99404","name":"Prev med cnsl indiv apprx 60","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12031","name":"Intmd rpr s/a/t/ext 2.5 cm/<","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3225","name":"Mans shoe oxford brace","description":"Orthopedic footwear, mans shoe, oxford, used as an integral part of a brace (orthosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19364","name":"Brst rcnstj free flap","description":"Breast reconstruction; with free flap (eg, ftram, diep, siea, gap flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1780.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27769","name":"Optx post ankle fx","description":"Open treatment of posterior malleolus fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":614.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6502","name":"Compres burngarment chinstrp","description":"Compression burn garment, chin strap, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27687","name":"Revision of calf tendon","description":"Gastrocnemius recession (eg, strayer procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":373.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26676","name":"Pin hand dislocation","description":"Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70470","name":"Ct head/brain w/o & w/dye","description":"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14061","name":"Tis trnfr e/n/e/l10.1-30sqcm","description":"Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":613.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34713","name":"Perq access & clsr fem art","description":"Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 french or larger), including ultrasound guidance, when performed, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4522","name":"Adult size brief/diaper med","description":"Adult sized disposable incontinence product, brief/diaper, medium, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57287","name":"Revise/remove sling repair","description":"Removal or revision of sling for stress incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":451.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95132","name":"Immntx 3 sting insects","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 3 stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35537","name":"Art byp grft aortoiliac","description":"Bypass graft, with vein; aortoiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83880","name":"Assay of natriuretic peptide","description":"Natriuretic peptide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33506","name":"Repair artery translocation","description":"Repair of anomalous coronary artery from pulmonary artery origin; by translocation from pulmonary artery to aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91038","name":"Esoph imped funct test > 1hr","description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to 24 hours)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45383","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":419.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97755","name":"Assistive technology assess","description":"Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92507","name":"Tx sp lang voice comm indiv","description":"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31770","name":"Repair/graft of bronchus","description":"Bronchoplasty; graft repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1064.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60252","name":"Removal of thyroid","description":"Thyroidectomy, total or subtotal for malignancy; with limited neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49495","name":"Rpr ing hernia baby reduc","description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0850","name":"Pwc gp 3 hd seat/back","description":"Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88280","name":"Chromosome karyotype study","description":"Chromosome analysis; additional karyotypes, each study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5950","name":"Endo ak ultra-light material","description":"Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85032","name":"Manual cell count each","description":"Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71015","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0966","name":"Wheelchair head rest extensi","description":"Manual wheelchair accessory, headrest extension, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83785","name":"Assay of manganese","description":"Manganese","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17340","name":"Cryotherapy for acne","description":"Cryotherapy (co2 slush, liquid n2) for acne","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62292","name":"Njx chemonucleolysis lmbr","description":"Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33800","name":"Aortic suspension","description":"Aortic suspension (aortopexy) for tracheal decompression (eg, for tracheomalacia) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52441","name":"Cysto insj trnsprstc 1 implt","description":"Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43648","name":"Lap revise/remv eltrd antrum","description":"Laparoscopy, surgical; revision or removal of gastric neurostimulator electrodes, antrum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":689.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00530","name":"Anes perm transvns pm insj","description":"Anesthesia for permanent transvenous pacemaker insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84545","name":"Urea-n clearance test","description":"Urea nitrogen, clearance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50396","name":"Measure kidney pressure","description":"Manometric studies through nephrostomy or pyelostomy tube, or indwelling ureteral catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6240","name":"Hydrocolld drg filler paste","description":"Hydrocolloid dressing, wound filler, paste, sterile, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34502","name":"Reconstruct vena cava","description":"Reconstruction of vena cava, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":821.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23470","name":"Reconstruct shoulder joint","description":"Arthroplasty, glenohumeral joint; hemiarthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1014.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76514","name":"Echo exam of eye thickness","description":"Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00910","name":"Anes transurethral px nos","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97606","name":"Neg prs wnd ther dme>50 sqcm","description":"Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (dme), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27259","name":"Treat hip dislocation","description":"Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shortening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1312.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99471","name":"Ped critical care initial","description":"Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":652.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93602","name":"Intra-atrial recording","description":"Intra-atrial recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54550","name":"Exploration for testis","description":"Exploration for undescended testis (inguinal or scrotal area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":398.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93264","name":"Rem mntr wrls p-art prs snr","description":"Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","name":"Lipid panel","description":"Lipid panel this panel must include the following: cholesterol, serum, total (82465) lipoprotein, direct measurement, high density cholesterol (hdl cholesterol) (83718) triglycerides (84478)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29015","name":"Appl rissr jacket bdy w/head","description":"Application of risser jacket, localizer, body; including head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44372","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with placement of percutaneous jejunostomy tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37205","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4706.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44388","name":"Colonoscopy thru stoma spx","description":"Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19316","name":"Mastopexy","description":"Mastopexy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53425","name":"Reconstruct urethra stage 2","description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11104","name":"Punch bx skin single lesion","description":"Punch biopsy of skin (including simple closure, when performed); single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42145","name":"Repair palate pharynx/uvula","description":"Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99451","name":"Ntrprof ph1/ntrnet/ehr 5/>","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a written report to the patients treating/requesting physician or other qualified health care professional, 5 mi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26520","name":"Release knuckle contracture","description":"Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":544.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95810","name":"Polysom 6/> yrs 4/> param","description":"Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96933","name":"Rcm i&r only 1st lesion","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; interpretation and report only, first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2292","name":"Planar seat for ped size wc","description":"Seat, planar, for pediatric size wheelchair including fixed attaching hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95056","name":"Photo tests","description":"Photo tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50040","name":"Nfros nfrot w/drg","description":"Nephrostomy, nephrotomy with drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":746.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90472","name":"Immunization admin each add","description":"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78130","name":"Red cell survival study","description":"Red cell survival study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65410","name":"Biopsy of cornea","description":"Biopsy of cornea","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38382","name":"Thoracic duct procedure","description":"Suture and/or ligation of thoracic duct; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46938","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63295","name":"Repair laminectomy defect","description":"Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86625","name":"Campylobacter antibody","description":"Antibody; campylobacter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78185","name":"Spleen imaging","description":"Spleen imaging only, with or without vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93285","name":"Prgrmg dev eval scrms ip","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; subcutaneous cardiac rhythm mon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55700","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93970","name":"Extremity study","description":"Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33251","name":"Ablate heart dysrhythm focus","description":"Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, wolff-parkinson-white, atrioventricular node re-entry), tract(s) and/or focus (foci); with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33982","name":"Replace vad intra w/o bp","description":"Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44130","name":"Bowel to bowel fusion","description":"Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4931","name":"Reusable oral thermometer","description":"Oral thermometer, reusable, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87899","name":"Agent nos assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72040","name":"X-ray exam neck spine 2-3 vw","description":"Radiologic examination, spine, cervical; 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19330","name":"Rmvl ruptured breast implant","description":"Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0483T","name":"Tmvi percutaneous approach","description":"Transcatheter mitral valve implantation/replacement (tmvi) with prosthetic valve; percutaneous approach, including transseptal puncture, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74235","name":"Remove esophagus obstruction","description":"Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0911","name":"Hd trapeze bar attach to bed","description":"Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21275","name":"Revision orbitofacial bones","description":"Secondary revision of orbitocraniofacial reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5850","name":"Endo ak/hip knee extens assi","description":"Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63040","name":"Laminotomy single cervical","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33764","name":"Shunt central w/prostc graft","description":"Shunt; central, with prosthetic graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1140.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35510","name":"Art byp grft carotid-brchial","description":"Bypass graft, with vein; carotid-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90834","name":"Psytx w pt 45 minutes","description":"Psychotherapy, 45 minutes with patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82365","name":"Calculus spectroscopy","description":"Calculus; infrared spectroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27077","name":"Resect hip tum w/innom bone","description":"Radical resection of tumor; innominate bone, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26841","name":"Fusion of thumb","description":"Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":613.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3763","name":"Ewho rigid w/o jnts cf","description":"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25020","name":"Decompress forearm 1 space","description":"Decompression fasciotomy, forearm and/or wrist, flexor or extensor compartment; without debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":529.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93242","name":"Ext ecg>48hr<7d recording","description":"External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; recording (includes connection and initial recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33364","name":"Replace aortic valve open","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open iliac artery approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1193.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99203","name":"Office o/p new low 30 min","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0952","name":"Toe loop/holder, each","description":"Toe loop/holder, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72292","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":333.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97608","name":"Neg prs wnd ther ndme>50sqcm","description":"Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surfac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35695","name":"Art trnsposj carotid subclav","description":"Transposition and/or reimplantation; carotid to subclavian artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21400","name":"Closed tx orbit w/o manipulj","description":"Closed treatment of fracture of orbit, except blowout; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47760","name":"Fuse bile ducts and bowel","description":"Anastomosis, of extrahepatic biliary ducts and gastrointestinal tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1883.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47533","name":"Plmt biliary drainage cath","description":"Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73620","name":"X-ray exam of foot","description":"Radiologic examination, foot; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67228","name":"Treatment x10sv retinopathy","description":"Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93325","name":"Doppler echo color flow mapg","description":"Doppler echocardiography color flow velocity mapping (list separately in addition to codes for echocardiography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8622","name":"Repl alkaline battery","description":"Alkaline battery for use with cochlear implant device, any size, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5968","name":"Multiaxial ankle w dorsiflex","description":"Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1770.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40500","name":"Partial excision of lip","description":"Vermilionectomy (lip shave), with mucosal advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":398.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34900","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":756.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31587","name":"Laryngoplasty cricoid split","description":"Laryngoplasty, cricoid split, without graft placement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":887.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25455","name":"Epiphysl arrst dstl rds&ulna","description":"Epiphyseal arrest by epiphysiodesis or stapling; distal radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":613.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58262","name":"Vag hyst including t/o","description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":593.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54430","name":"Revision of penis","description":"Corpora cavernosa-corpus spongiosum shunt (priapism operation), unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89125","name":"Specimen fat stain","description":"Fat stain, feces, urine, or respiratory secretions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28446","name":"Opn osteochondrl agrft talus","description":"Open osteochondral autograft, talus (includes obtaining graft[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20680","name":"Removal of implant deep","description":"Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44390","name":"Colonoscopy for foreign body","description":"Colonoscopy through stoma; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46230","name":"Removal of anal tags","description":"Excision of multiple external papillae or tags, anus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65150","name":"Revise ocular implant","description":"Reinsertion of ocular implant; with or without conjunctival graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82570","name":"Assay of urine creatinine","description":"Creatinine; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57295","name":"Revise vag graft via vagina","description":"Revision (including removal) of prosthetic vaginal graft; vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":312.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75756","name":"Artery x-rays chest","description":"Angiography, internal mammary, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00634","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28116","name":"Revision of foot","description":"Ostectomy, excision of tarsal coalition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5699","name":"Shoulder harness","description":"All lower extremity prostheses, shoulder harness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5010","name":"Mold socket ank hgt w/ toe f","description":"Partial foot, molded socket, ankle height, with toe filler","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":767.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31535","name":"Laryngoscopy w/biopsy","description":"Laryngoscopy, direct, operative, with biopsy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54250","name":"Nctrnl pen tmscn&/rgdity tst","description":"Nocturnal penile tumescence and/or rigidity test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61598","name":"Transpetrosal approach/skull","description":"Transpetrosal approach to posterior cranial fossa, clivus or foramen magnum, including ligation of superior petrosal sinus and/or sigmoid sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2588.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58291","name":"Vag hyst incl t/o complex","description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":800.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64746","name":"Incise diaphragm nerve","description":"Transection or avulsion of; phrenic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44127","name":"Enterectomy w/taper cong","description":"Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; with tapering","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92519","name":"Vemp tst i&r cervical&ocular","description":"Vestibular evoked myogenic potential (vemp) testing, with interpretation and report; cervical (cvemp) and ocular (ovemp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10040","name":"Extraction","description":"Extraction (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6237","name":"Hydrocolld drg <=16 in w/bdr","description":"Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87184","name":"Sc std disk method per plate","description":"Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33726","name":"Repair pul venous stenosis","description":"Repair of pulmonary venous stenosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69806","name":"Explore inner ear","description":"Endolymphatic sac operation; with shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4533","name":"Youth size brief/diaper","description":"Youth sized disposable incontinence product, brief/diaper, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86790","name":"Virus antibody nos","description":"Antibody; virus, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29899","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":864.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5073","name":"Urinary pouch on barr w/flng","description":"Ostomy pouch, urinary; for use on barrier with flange (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0603","name":"Repl batt alkaline 1.5 v","description":"Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31238","name":"Nsl/sins ndsc srg nsl hemrrg","description":"Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77763","name":"Apply intrcav radiat compl","description":"Intracavitary radiation source application; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1005","name":"Pwr seat recline pwr","description":"Wheelchair accessory, power seating system, recline only, with power shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36514","name":"Apheresis plasma","description":"Therapeutic apheresis; for plasma pheresis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":542.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83050","name":"Hgb methemoglobin quan","description":"Hemoglobin; methemoglobin, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57270","name":"Repair of bowel pouch","description":"Repair of enterocele, abdominal approach (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83625","name":"Assay of ldh enzymes","description":"Lactate dehydrogenase (ld), (ldh); isoenzymes, separation and quantitation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41828","name":"Excision of gum lesion","description":"Excision of hyperplastic alveolar mucosa, each quadrant (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61697","name":"Brain aneurysm repr complx","description":"Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4340","name":"Indwelling catheter special","description":"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87147","name":"Culture type immunologic","description":"Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6247","name":"Hydrogel drg > 48 sq in w/b","description":"Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77261","name":"Ther radiology tx plng smpl","description":"Therapeutic radiology treatment planning; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88332","name":"Path consltj surg ea add blk","description":"Pathology consultation during surgery; each additional tissue block with frozen section(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33782","name":"Nikaidoh proc","description":"Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, nikaidoh procedure); without coronary ostium reimplantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2820.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4280","name":"Brst prsths adhsv attchmnt","description":"Adhesive skin support attachment for use with external breast prosthesis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95928","name":"C motor evoked uppr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); upper limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8686","name":"Implt nrostm pls gen sng non","description":"Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4064.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35490","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":627.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76529","name":"Echo exam of eye","description":"Ophthalmic ultrasonic foreign body localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55400","name":"Repair of sperm duct","description":"Vasovasostomy, vasovasorrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":404.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75625","name":"Contrast exam abdominl aorta","description":"Aortography, abdominal, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92577","name":"Stenger test speech","description":"Stenger test, speech","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37140","name":"Revision of circulation","description":"Venous anastomosis, open; portocaval","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2045.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92312","name":"Contact lens fitg aphakia ou","description":"Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, both eyes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84133","name":"Assay of urine potassium","description":"Potassium; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15772","name":"Grfg autol fat lipo ea addl","description":"Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44210","name":"Laparo total proctocolectomy","description":"Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1423.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3370","name":"Shoe sole wedge between sole","description":"Sole wedge, between sole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40800","name":"Drainage of mouth lesion","description":"Drainage of abscess, cyst, hematoma, vestibule of mouth; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52250","name":"Cystoscopy and radiotracer","description":"Cystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68500","name":"Removal of tear gland","description":"Excision of lacrimal gland (dacryoadenectomy), except for tumor; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11043","name":"Dbrdmt musc&/fsca 1st 20/<","description":"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78140","name":"Red cell sequestration","description":"Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27027","name":"Dcmprn fasct pel compartment","description":"Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":752.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0423","name":"Intens cardiac rehab no exer","description":"Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81000","name":"Urinalysis nonauto w/scope","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","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76498","name":"Unlisted mr procedure","description":"Unlisted magnetic resonance procedure (eg, diagnostic, interventional)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43338","name":"Esoph lengthening","description":"Esophageal lengthening procedure (eg, collis gastroplasty or wedge gastroplasty) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4625","name":"Trach care kit for new trach","description":"Tracheostomy care kit for new tracheostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10010","name":"Fna bx w/ct gdn ea addl","description":"Fine needle aspiration biopsy, including ct guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95865","name":"Needle emg larynx","description":"Needle electromyography; larynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31545","name":"Remove vc lesion w/scope","description":"Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2228","name":"Mwc acc, wheelchair brake","description":"Manual wheelchair accessory, wheel braking system and lock, complete, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43278","name":"Ercp lesion ablate w/dilate","description":"Endoscopic retrograde cholangiopancreatography (ercp); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":332.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47420","name":"Incision of bile duct","description":"Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; without transduodenal sphincterotomy or sphincteroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1118.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8621","name":"Repl zinc air battery","description":"Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73562","name":"X-ray exam of knee 3","description":"Radiologic examination, knee; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60521","name":"Removal of thymus gland","description":"Thymectomy, partial or total; sternal split or transthoracic approach, without radical mediastinal dissection (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96000","name":"Motion analysis video/3d","description":"Comprehensive computer-based motion analysis by video-taping and 3d kinematics;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49013","name":"Prpertl pel pack hemrrg trma","description":"Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma, including local exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":352.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71035","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21750","name":"Repair of sternum separation","description":"Closure of median sternotomy separation with or without debridement (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46505","name":"Chemodenervation anal musc","description":"Chemodenervation of internal anal sphincter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0458","name":"Tlso 2mod symphis-xipho pre","description":"Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagitta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86336","name":"Inhibin a","description":"Inhibin a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38222","name":"Dx bone marrow bx & aspir","description":"Diagnostic bone marrow; biopsy(ies) and aspiration(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81179","name":"Atxn2 gene detc abnor allele","description":"Atxn2 (ataxin 2) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37222","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27470","name":"Repair of thigh","description":"Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95990","name":"Spin/brain pump refil & main","description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99441","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84165","name":"Protein e-phoresis serum","description":"Protein; electrophoretic fractionation and quantitation, serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87500","name":"Vanomycin dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); vancomycin resistance (eg, enterococcus species van a, van b), amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74485","name":"Dilation urtr/urt rs&i","description":"Dilation of ureter(s) or urethra, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11100","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25272","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74400","name":"Urography iv +-kub tomog","description":"Urography (pyelography), intravenous, with or without kub, with or without tomography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93641","name":"Ep evl 1/2chmb pac cvdfb tst","description":"Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44380","name":"Small bowel endoscopy br/wa","description":"Ileoscopy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6645","name":"Shoulder flexion-abduction j","description":"Upper extremity addition, shoulder flexion-abduction joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0509","name":"Crit care telehea consult 50","description":"Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88147","name":"Cytopath c/v automated","description":"Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0108T","name":"Cool quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using cooling stimuli to assess small nerve fiber sensation and hyperalgesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73503","name":"X-ray exam hip uni 4/> views","description":"Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57460","name":"Bx of cervix w/scope leep","description":"Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27445","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1064.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70350","name":"X-ray head for orthodontia","description":"Cephalogram, orthodontic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2830","name":"Soft interface above knee se","description":"Addition to lower extremity orthosis, soft interface for molded plastic, above knee section","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17108","name":"Dstr cut vsc prlf les>50sqcm","description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6021","name":"Collagen dressing <=16 sq in","description":"Collagen dressing, sterile, size 16 sq. in. or less, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0249","name":"Provide inr test mater/equip","description":"Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47535","name":"Conversion ext bil drg cath","description":"Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":759.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82042","name":"Other source albumin quan ea","description":"Albumin; other source, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15572","name":"Skin pedicle flap arms/legs","description":"Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43775","name":"Lap sleeve gastrectomy","description":"Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":939.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27035","name":"Denervation of hip joint","description":"Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0145","name":"Scr c/v cyto,thinlayer,rescr","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25320","name":"Repair/revise wrist joint","description":"Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37780","name":"Revision of leg vein","description":"Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24940","name":"Revision of upper arm","description":"Cineplasty, upper extremity, complete procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86318","name":"Ia infectious agent antibody","description":"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33863","name":"Ascending aortic graft","description":"Ascending aorta graft, with cardiopulmonary bypass, with aortic root replacement using valved conduit and coronary reconstruction (eg, bentall)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1298","name":"Wheelchair spec seat depth/w","description":"Special wheelchair seat depth and/or width, by construction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E8000","name":"Posterior gait trainer","description":"Gait trainer, pediatric size, posterior support, includes all accessories and components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96125","name":"Cognitive test by hc pro","description":"Standardized cognitive performance testing (eg, ross information processing assessment) per hour of a qualified health care professionals time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93529","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0585","name":"Nebulizer w/ compressor & he","description":"Nebulizer, with compressor and heater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87637","name":"Sarscov2&inf a&b&rsv amp prb","description":"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), influenza virus types a and b, and respiratory syncytial virus, multiplex amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74247","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70552","name":"Mri brain stem w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75946","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21345","name":"Closed tx nose/jaw fx","description":"Closed treatment of nasomaxillary complex fracture (lefort ii type), with interdental wire fixation or fixation of denture or splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":636.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2367","name":"Battery charger, dual mode","description":"Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11312","name":"Shave skin lesion 1.1-2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57452","name":"Exam of cervix w/scope","description":"Colposcopy of the cervix including upper/adjacent vagina;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6412","name":"Occlusive eye patch","description":"Eye patch, occlusive, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68328","name":"Revise/graft eyelid lining","description":"Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":427.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25107","name":"Remove wrist joint cartilage","description":"Arthrotomy, distal radioulnar joint including repair of triangular cartilage, complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33745","name":"Tis cgen car anomal 1st shnt","description":"Transcatheter intracardiac shunt (tis) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78700","name":"Kidney imaging morphol","description":"Kidney imaging morphology;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85366","name":"Fibrinogen test","description":"Fibrin(ogen) degradation (split) products (fdp) (fsp); paracoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81189","name":"Cstb gene full gene sequence","description":"Cstb (cystatin b) (eg, unverricht-lundborg disease) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55100","name":"Drainage of scrotum abscess","description":"Drainage of scrotal wall abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15002","name":"Wound prep trk/arm/leg","description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55866","name":"Laps surg prst8ect rpbic rad","description":"Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17000","name":"Destruct premalg lesion","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78430","name":"Myocrd img pet rst/strs w/ct","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47612","name":"Removal of gallbladder","description":"Cholecystectomy with exploration of common duct; with choledochoenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1070.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25574","name":"Optx rdl&uln shft fx rds/uln","description":"Open treatment of radial and ulnar shaft fractures, with internal fixation, when performed; of radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":565.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69601","name":"Revj mstdc rsltg compl mstdc","description":"Revision mastoidectomy; resulting in complete mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":830.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61518","name":"Removal of brain lesion","description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2537.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0496","name":"Battery elec/combo vad, rep","description":"Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75743","name":"Artery x-rays lungs","description":"Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7017","name":"Nebulizer not used w oxygen","description":"Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01730","name":"Anes clsd px humerus&elbow","description":"Anesthesia for all closed procedures on humerus and elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98971","name":"Nqhp ol dig assmt&mgmt 11-20","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25301","name":"Fusion of tendons at wrist","description":"Tenodesis at wrist; extensors of fingers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27715","name":"Ostpl tibfib lngth/shrt","description":"Osteoplasty, tibia and fibula, lengthening or shortening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":907.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50370","name":"Rmvl transplanted rnl algrft","description":"Removal of transplanted renal allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1044.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7000","name":"Disposable canister for pump","description":"Canister, disposable, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","KE","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6712","name":"Ped term dev, hook, vol clos","description":"Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75870","name":"Vein x-ray skull","description":"Venography, superior sagittal sinus, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0730","name":"Ctrl dose inh drug deliv sys","description":"Controlled dose inhalation drug delivery system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61345","name":"Oth cranial dcmprn pst fossa","description":"Other cranial decompression, posterior fossa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1237","name":"Rgd ped wc adjstabl w/o seat","description":"Wheelchair, pediatric size, rigid, adjustable, without seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36000","name":"Place needle in vein","description":"Introduction of needle or intracatheter, vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28292","name":"Cor hlx vlgs rsc prx phlx bs","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":585.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74712","name":"Mri fetal sngl/1st gestation","description":"Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63180","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1353.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7025","name":"Replace chest compress vest","description":"High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2783","name":"Lens, >= 1.66 p/>=1.80 g","description":"Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24535","name":"Cltx sprcndylr humeral fx w/","description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":516.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0480T","name":"Fxjl abl lsr ea addl 100sqcm","description":"Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00880","name":"Anes maj lwr abd vessel nos","description":"Anesthesia for procedures on major lower abdominal vessels; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84482","name":"T3 reverse","description":"Triiodothyronine t3; reverse","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82523","name":"Collagen crosslinks","description":"Collagen cross links, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79200","name":"Nuclear rx intracav admin","description":"Radiopharmaceutical therapy, by intracavitary administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11440","name":"Exc face-mm b9+marg 0.5 cm/<","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35903","name":"Excision graft extremity","description":"Excision of infected graft; extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":493.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31511","name":"Remove foreign body larynx","description":"Laryngoscopy, indirect; with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2128","name":"Kafo fem fx cast molded to p","description":"Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35361","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; combined aortoiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1345.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99344","name":"Home/res vst new mod mdm 60","description":"Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84379","name":"Sugars multiple quant","description":"Sugars (mono-, di-, and oligosaccharides); multiple quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85055","name":"Reticulated platelet assay","description":"Reticulated platelet assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33935","name":"Transplantation heart/lung","description":"Heart-lung transplant with recipient cardiectomy-pneumonectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4330.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27327","name":"Exc thigh/knee les sc < 3 cm","description":"Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":405.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26560","name":"Repair of web finger","description":"Repair of syndactyly (web finger) each web space; with skin flaps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":504.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26562","name":"Repair of web finger","description":"Repair of syndactyly (web finger) each web space; complex (eg, involving bone, nails)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43320","name":"Fuse esophagus & stomach","description":"Esophagogastrostomy (cardioplasty), with or without vagotomy and pyloroplasty, transabdominal or transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1171.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70240","name":"X-ray exam pituitary saddle","description":"Radiologic examination, sella turcica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88121","name":"Cytp urine 3-5 probes cmptr","description":"Cytopathology, in situ hybridization (eg, fish), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55880","name":"Abltj mal prst8 tiss hifu","description":"Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (hifu), including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":791.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47554","name":"Biliary endoscopy thru skin","description":"Biliary endoscopy, percutaneous via t-tube or other tract; with removal of calculus/calculi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":433.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4300","name":"Cath impl vasc access portal","description":"Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32551","name":"Insertion of chest tube","description":"Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85520","name":"Heparin assay","description":"Heparin assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43610","name":"Excision of stomach lesion","description":"Excision, local; ulcer or benign tumor of stomach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2008","name":"Post-d/c h vst ext pt 45 m","description":"Moderate (45 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient fac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7040","name":"One way chest drain valve","description":"One way chest drain valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82055","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44720","name":"Prep donor intestine/venous","description":"Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82379","name":"Assay of carnitine","description":"Carnitine (total and free), quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4433","name":"Urine ost pch bar w lock fln","description":"Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29870","name":"Arthrs knee dx w/wo syn bx","description":"Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93281","name":"Pm device progr eval multi","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25675","name":"Cltx dstl rad/uln dislc mnpj","description":"Closed treatment of distal radioulnar dislocation with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":370.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75822","name":"Vein x-ray arms/legs","description":"Venography, extremity, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0100","name":"Cane adjust/fixed with tip","description":"Cane, includes canes of all materials, adjustable or fixed, with tip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50606","name":"Endoluminal bx urtr rnl plvs","description":"Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88309","name":"Tissue exam by pathologist","description":"Level vi - surgical pathology, gross and microscopic examination bone resection breast, mastectomy - with regional lymph nodes colon, segmental resection for tumor colon, total resection esophagus, partial/total resection extremity, disarticulation fetus, with dissection larynx, partial/total resect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00802","name":"Anes px lwr abdl wal pannic","description":"Anesthesia for procedures on lower anterior abdominal wall; panniculectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86403","name":"Particle agglut antbdy scrn","description":"Particle agglutination; screen, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00147","name":"Anes px on eye iridectomy","description":"Anesthesia for procedures on eye; iridectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15274","name":"Skn sub grft t/a/l child add","description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67415","name":"Aspiration orbital contents","description":"Fine needle aspiration of orbital contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0329","name":"Electromagntic tx for ulcers","description":"Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0408","name":"Inpt/tele follow up 35","description":"Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25560","name":"Cltx rdl&uln shft fx wo mnpj","description":"Closed treatment of radial and ulnar shaft fractures; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19126","name":"Excision addl breast lesion","description":"Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01360","name":"Anes open px lower 1/3 femur","description":"Anesthesia for all open procedures on lower one-third of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00820","name":"Anes px lwr post abdl wall","description":"Anesthesia for procedures on lower posterior abdominal wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84270","name":"Assay of sex hormone globul","description":"Sex hormone binding globulin (shbg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86486","name":"Skin test unlisted antign ea","description":"Skin test; unlisted antigen, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55100","name":"Drainage of scrotum abscess","description":"Drainage of scrotal wall abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33755","name":"Shunt as-aort to pulm art","description":"Shunt; ascending aorta to pulmonary artery (waterston type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1140.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96409","name":"Chemo iv push sngl drug","description":"Chemotherapy administration; intravenous, push technique, single or initial substance/drug","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28226","name":"Release of foot tendons","description":"Tenolysis, extensor, foot; multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28024","name":"Exploration of toe joint","description":"Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00402","name":"Anes integ sys rcnstv breast","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; reconstructive procedures on breast (eg, reduction or augmentation mammoplasty, muscle flaps)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5640","name":"Knee disarticulat leather so","description":"Addition to lower extremity, knee disarticulation, leather socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6380","name":"Postop dsg cast chg wrst/elb","description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84376","name":"Sugars single qual","description":"Sugars (mono-, di-, and oligosaccharides); single qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28088","name":"Excise foot tendon sheath","description":"Synovectomy, tendon sheath, foot; extensor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":352.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4159","name":"Ef ped complete soy based","description":"Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0165T","name":"Revise lumb artif disc addl","description":"Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72148","name":"Mri lumbar spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0468","name":"Tlso rig fram pelvic pre cst","description":"Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86077","name":"Phys blood bank serv xmatch","description":"Blood bank physician services; difficult cross match and/or evaluation of irregular antibody(s), interpretation and written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29855","name":"Tibial arthroscopy/surgery","description":"Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":658.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96406","name":"Chemo intralesional over 7","description":"Chemotherapy administration; intralesional, more than 7 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2501","name":"Cntct lens pmma-toric/prism","description":"Contact lens, pmma, toric or prism ballast, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33265","name":"Ablate atria lmtd endo","description":"Endoscopy, surgical; operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure), without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1177.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2313","name":"Pwc harness, expand control","description":"Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90581","name":"Anthrax vaccine sc or im","description":"Anthrax vaccine, for subcutaneous or intramuscular use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46744","name":"Repair of cloacal anomaly","description":"Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, sacroperineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95180","name":"Rapid desensitization","description":"Rapid desensitization procedure, each hour (eg, insulin, penicillin, equine serum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45391","name":"Colonoscopy w/endoscope us","description":"Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15736","name":"Muscle-skin graft arm","description":"Muscle, myocutaneous, or fasciocutaneous flap; upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70553","name":"Mri brain stem w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5512","name":"Multi den insert direct form","description":"For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patients foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83690","name":"Assay of lipase","description":"Lipase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92546","name":"Sinusoidal rotational test","description":"Sinusoidal vertical axis rotational testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25520","name":"Cltx rdl shft fx&dislc","description":"Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (galeazzi fracture/dislocation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95725","name":"Eeg phy/qhp>84 hr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of eeg recording, without video","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28760","name":"Fusion of big toe joint","description":"Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, jones type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34808","name":"Endovas iliac a device addon","description":"Endovascular placement of iliac artery occlusion device (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92550","name":"Tympanometry & reflex thresh","description":"Tympanometry and reflex threshold measurements","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25442","name":"Arthrp w/prostc dstl ulna","description":"Arthroplasty with prosthetic replacement; distal ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":674.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99343","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86812","name":"Hla typing a b or c","description":"Hla typing; a, b, or c (eg, a10, b7, b27), single antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6692","name":"Silicon gel insert w/wo lock","description":"Upper extremity addition, silicone gel insert or equal, with or without locking mechanism, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":281.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13160","name":"Sec clsr surg wnd/dehsn xtn","description":"Secondary closure of surgical wound or dehiscence, extensive or complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61539","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, with electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85347","name":"Coagulation time activated","description":"Coagulation time; activated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0853","name":"Pwc gp 3 vhd cap chair","description":"Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77295","name":"3-d radiotherapy plan","description":"3-dimensional radiotherapy plan, including dose-volume histograms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3982","name":"Upper ext fx orthosis rad/ul","description":"Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61520","name":"Removal of brain lesion","description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95967","name":"Meg evoked each addl","description":"Magnetoencephalography (meg), recording and analysis; for evoked magnetic fields, each additional modality (eg, sensory, motor, language, or visual cortex localization) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61575","name":"Skull base/brainstem surgery","description":"Transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82963","name":"Assay of glucosidase","description":"Glucosidase, beta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91037","name":"Esoph imped function test","description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68400","name":"I&d lacrimal gland","description":"Incision, drainage of lacrimal gland","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4322","name":"Irrigation syringe","description":"Irrigation syringe, bulb or piston, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49423","name":"Exchange drainage catheter","description":"Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27606","name":"Incision of achilles tendon","description":"Tenotomy, percutaneous, achilles tendon (separate procedure); general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22856","name":"Tot disc arthrp 1ntrspc crv","description":"Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25251","name":"Removal of wrist prosthesis","description":"Removal of wrist prosthesis; complicated, including total wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":607.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63052","name":"Lam facetc/frmt arthrd lum 1","description":"Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment (list separately in addition to code for primary ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97537","name":"Community/work reintegration","description":"Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51597","name":"Removal of pelvic structures","description":"Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1863.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67715","name":"Canthotomy","description":"Canthotomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11426","name":"Exc h-f-nk-sp b9+marg >4 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64435","name":"Njx aa&/strd paracrv nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; paracervical (uterine) nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95991","name":"Spin/brain pump refil & main","description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring skill of a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87283","name":"Rubeola ag if","description":"Infectious agent antigen detection by immunofluorescent technique; rubeola","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46748","name":"Repair of cloacal anomaly","description":"Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach; with vaginal lengthening by intestinal graft or pedicle flaps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86341","name":"Islet cell antibody","description":"Islet cell antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1730","name":"Legg perthes orth scottish r","description":"Legg perthes orthosis, (scottish rite type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":541.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60280","name":"Remove thyroid duct lesion","description":"Excision of thyroglossal duct cyst or sinus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27646","name":"Resect fibula tumor","description":"Radical resection of tumor; fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87336","name":"Entamoeb hist dispr ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; entamoeba histolytica dispar group","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0049","name":"Alcohol/drug screening","description":"Alcohol and/or drug screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35537","name":"Art byp grft aortoiliac","description":"Bypass graft, with vein; aortoiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1845.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84035","name":"Assay of phenylketones","description":"Phenylketones, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50810","name":"Fusion of ureter & bowel","description":"Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of abdominal or perineal colostomy, including intestine anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1227.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0308","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":409.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73702","name":"Ct lwr extremity w/o&w/dye","description":"Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33777","name":"Rpr tga bfl rpr sbpulm obstr","description":"Repair of transposition of the great arteries, atrial baffle procedure (eg, mustard or senning type) with cardiopulmonary bypass; with repair of subpulmonic obstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1645.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33256","name":"Ablate atria w/bypass exten","description":"Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78431","name":"Myocrd img pet rst&strs ct","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1845.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87341","name":"Hep b surface ag neutrlzj ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hepatitis b surface antigen (hbsag) neutralization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43245","name":"Egd dilate stricture","description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94774","name":"Ped home apnea mntr evnt rec","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, review, interpretation, and preparation of a report by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":224.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74248","name":"X-ray sm int f-thru std","description":"Radiologic small intestine follow-through study, including multiple serial images (list separately in addition to code for primary procedure for upper gi radiologic examination)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86645","name":"Cmv antibody igm","description":"Antibody; cytomegalovirus (cmv), igm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82928","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88173","name":"Cytopath eval fna report","description":"Cytopathology, evaluation of fine needle aspirate; interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8045","name":"Auricular prosthesis","description":"Auricular prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","KM","95","93","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93271","name":"Ecg/monitoring and analysis","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; transmission and analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67825","name":"Revise eyelashes","description":"Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery, cryotherapy, laser surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42505","name":"Repair salivary duct","description":"Plastic repair of salivary duct, sialodochoplasty; secondary or complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86079","name":"Phys blood bank serv authrj","description":"Blood bank physician services; authorization for deviation from standard blood banking procedures (eg, use of outdated blood, transfusion of rh incompatible units), with written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15630","name":"Delay flap eye/nos/ear/lip","description":"Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":285.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27680","name":"Release of lower leg tendon","description":"Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43621","name":"Removal of stomach","description":"Gastrectomy, total; with roux-en-y reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6243","name":"Hydrogel drg >16<=48 w/o bdr","description":"Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6004","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73720","name":"Mri lwr extremity w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52270","name":"Cystoscopy & revise urethra","description":"Cystourethroscopy, with internal urethrotomy; female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2396","name":"Caster fork","description":"Power wheelchair accessory, caster fork, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57550","name":"Removal of residual cervix","description":"Excision of cervical stump, vaginal approach;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87496","name":"Cytomeg dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); cytomegalovirus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72126","name":"Ct neck spine w/dye","description":"Computed tomography, cervical spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28760","name":"Fusion of big toe joint","description":"Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, jones type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":634.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1060","name":"Wheelchair detachable arms","description":"Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82330","name":"Assay of calcium","description":"Calcium; ionized","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26111","name":"Exc hand les sc 1.5 cm/>","description":"Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; 1.5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86788","name":"West nile virus ab igm","description":"Antibody; west nile virus, igm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84510","name":"Assay of tyrosine","description":"Tyrosine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44715","name":"Prepare donor intestine","description":"Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8684","name":"Radiof trsmtr implt scrl neu","description":"Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95913","name":"Nrv cndj test 13/> studies","description":"Nerve conduction studies; 13 or more studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19350","name":"Nipple/areola reconstruction","description":"Nipple/areola reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0001","name":"Standard wheelchair","description":"Standard wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20205","name":"Deep muscle biopsy","description":"Biopsy, muscle; deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01404","name":"Anes opn/arthrs disrtcj knee","description":"Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35548","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1241.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37185","name":"Prim art m-thrmbc sbsq vsl","description":"Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (list separa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":299.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66920","name":"Extraction of lens","description":"Removal of lens material; intracapsular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":451.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4930","name":"Sterile, gloves per pair","description":"Gloves, sterile, per pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01470","name":"Anes px nrv msc lw l/a/f nos","description":"Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33310","name":"Exploratory heart surgery","description":"Cardiotomy, exploratory (includes removal of foreign body, atrial or ventricular thrombus); without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1010.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92597","name":"Oral speech device eval","description":"Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61590","name":"Infratemporal approach/skull","description":"Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline skull base, nasopharynx), with or without disarticulation of the mandible, including parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve and/or petrous carotid a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2557.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94690","name":"O2 uptk rest indirect","description":"Oxygen uptake, expired gas analysis; rest, indirect (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12011","name":"Rpr f/e/e/n/l/m 2.5 cm/<","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45550","name":"Repair rectum/remove sigmoid","description":"Proctopexy (eg, for prolapse); with sigmoid resection, abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81003","name":"Urinalysis auto w/o scope","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, without microscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4431","name":"Ost pch urine w barrier/tapv","description":"Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36901","name":"Intro cath dialysis circuit","description":"Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":345.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74235","name":"Remove esophagus obstruction","description":"Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76930","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0445","name":"Oximeter non-invasive","description":"Oximeter device for measuring blood oxygen levels non-invasively","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87147","name":"Culture type immunologic","description":"Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95808","name":"Polysom any age 1-3> param","description":"Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":441.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59841","name":"Induced abortion dilat&evac","description":"Induced abortion, by dilation and evacuation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0300","name":"Enclosed ped crib hosp grade","description":"Pediatric crib, hospital grade, fully enclosed, with or without top enclosure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82105","name":"Alpha-fetoprotein serum","description":"Alpha-fetoprotein (afp); serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88362","name":"Nerve teasing preparations","description":"Nerve teasing preparations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82378","name":"Carcinoembryonic antigen","description":"Carcinoembryonic antigen (cea)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47712","name":"Excision of bile duct tumor","description":"Excision of bile duct tumor, with or without primary repair of bile duct; intrahepatic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3891","name":"Torsion mechanism wrist/elbo","description":"Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24346","name":"Reconstruct elbow med ligmnt","description":"Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32662","name":"Thoracoscopy w/mediast exc","description":"Thoracoscopy, surgical; with excision of mediastinal cyst, tumor, or mass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50725","name":"Release/revise ureter","description":"Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1090","name":"Lumbar sling","description":"Addition to ctlso or scoliosis orthosis, lumbar sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86431","name":"Rheumatoid factor quant","description":"Rheumatoid factor; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65765","name":"Keratophakia","description":"Keratophakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":601.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25905","name":"Amputation of forearm","description":"Amputation, forearm, through radius and ulna; open, circular (guillotine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":592.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40810","name":"Excision of mouth lesion","description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57550","name":"Removal of residual cervix","description":"Excision of cervical stump, vaginal approach;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":269.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15200","name":"Fth/gft fr trnk 20 sq cm/<","description":"Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":528.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35082","name":"Repair artery rupture aorta","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1923.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73219","name":"Mri upper extremity w/dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33778","name":"Rpr tga aortic pulm art rcns","description":"Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, jatene type);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2045.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96910","name":"Photchmtx tar&uvb/ptrltm&uvb","description":"Photochemotherapy; tar and ultraviolet b (goeckerman treatment) or petrolatum and ultraviolet b","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17262","name":"Dstrj mal les t/a/l 1.1-2.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77317","name":"Brachytx isodose intermed","description":"Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85999","name":"Unlisted hematology&coagj px","description":"Unlisted hematology and coagulation procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27607","name":"Treat lower leg bone lesion","description":"Incision (eg, osteomyelitis or bone abscess), leg or ankle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75559","name":"Cardiac mri w/stress img","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":347.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36861","name":"Cannula declotting","description":"External cannula declotting (separate procedure); with balloon catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97610","name":"Low frequency non-thermal us","description":"Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50432","name":"Plmt nephrostomy catheter","description":"Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77407","name":"Radiation tx delivery lvl 2","description":"Radiation treatment delivery; level 2, single-isocenter (eg, 3d or imrt), photons, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69300","name":"Revise external ear","description":"Otoplasty, protruding ear, with or without size reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":501.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0853","name":"Pwc gp 3 vhd cap chair","description":"Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57111","name":"Vagnc compl rmvl paravag tis","description":"Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1091.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43313","name":"Esophagoplasty congenital","description":"Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; without repair of congenital tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15273","name":"Skin sub grft t/arm/lg child","description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00542","name":"Anes thrcm px decortication","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); decortication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27466","name":"Lengthening of thigh bone","description":"Osteoplasty, femur; lengthening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1003.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96402","name":"Chemo hormon antineopl sq/im","description":"Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G9043","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87537","name":"Hiv-2 dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-2, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0501","name":"Shwr cov elec/combo vad, rep","description":"Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89060","name":"Exam synovial fluid crystals","description":"Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69604","name":"Revj mstdc rsltg tympanplsty","description":"Revision mastoidectomy; resulting in tympanoplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":897.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15934","name":"Exc sacral pr ulc skn flap","description":"Excision, sacral pressure ulcer, with skin flap closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84163","name":"Pappa serum","description":"Pregnancy-associated plasma protein-a (papp-a)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77427","name":"Radiation tx management x5","description":"Radiation treatment management, 5 treatments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92640","name":"Aud brainstem implt programg","description":"Diagnostic analysis with programming of auditory brainstem implant, per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78071","name":"Parathyrd planar w/wo subtrj","description":"Parathyroid planar imaging (including subtraction, when performed); with tomographic (spect)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20701","name":"Rmvl deep rx delivery device","description":"Removal of drug-delivery device(s), deep (eg, subfascial) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00148","name":"Anes px eye ophthalmoscopy","description":"Anesthesia for procedures on eye; ophthalmoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49324","name":"Lap insert tunnel ip cath","description":"Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S2083","name":"Adjustment gastric band","description":"Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25126","name":"Remove/graft forearm lesion","description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":503.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43312","name":"Repair esophagus and fistula","description":"Esophagoplasty (plastic repair or reconstruction), thoracic approach; with repair of tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87150","name":"Dna/rna amplified probe","description":"Culture, typing; identification by nucleic acid (dna or rna) probe, amplified probe technique, per culture or isolate, each organism probed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33511","name":"Cabg vein two","description":"Coronary artery bypass, vein only; 2 coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62264","name":"Epidural lysis on single day","description":"Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54901","name":"Fusion of spermatic ducts","description":"Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41116","name":"Excision of mouth lesion","description":"Excision, lesion of floor of mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21742","name":"Repair stern/nuss w/o scope","description":"Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (nuss procedure), without thoracoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26542","name":"Repair hand joint with graft","description":"Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":575.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86674","name":"Giardia lamblia antibody","description":"Antibody; giardia lamblia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27254","name":"Treat hip dislocation","description":"Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70380","name":"X-ray exam of salivary gland","description":"Radiologic examination, salivary gland for calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93325","name":"Doppler echo color flow mapg","description":"Doppler echocardiography color flow velocity mapping (list separately in addition to codes for echocardiography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42890","name":"Limited pharyngectomy","description":"Limited pharyngectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1107.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35518","name":"Art byp grft axillary-axilry","description":"Bypass graft, with vein; axillary-axillary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1009.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0146","name":"Nav srv peer sup add 30 pr m","description":"Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49080","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87254","name":"Virus inoculation shell via","description":"Virus isolation; centrifuge enhanced (shell vial) technique, includes identification with immunofluorescence stain, each virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4217","name":"Sterile water/saline, 500 ml","description":"Sterile water/saline, 500 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","AU","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57420","name":"Exam of vagina w/scope","description":"Colposcopy of the entire vagina, with cervix if present;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66155","name":"Glaucoma surgery","description":"Fistulization of sclera for glaucoma; thermocauterization with iridectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":528.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35266","name":"Rpr blvsl grf oth/th vn uxtr","description":"Repair blood vessel with graft other than vein; upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":755.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2385","name":"Tube, pneumatic caster tire","description":"Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43305","name":"Repair esophagus and fistula","description":"Esophagoplasty (plastic repair or reconstruction), cervical approach; with repair of tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":847.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15734","name":"Muscle-skin graft trunk","description":"Muscle, myocutaneous, or fasciocutaneous flap; trunk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0416","name":"Prostate biopsy, any mthd","description":"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44110","name":"Excise intestine lesion(s)","description":"Excision of 1 or more lesions of small or large intestine not requiring anastomosis, exteriorization, or fistulization; single enterotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73702","name":"Ct lwr extremity w/o&w/dye","description":"Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2010","name":"Kafo sng solid stirrup w/o j","description":"Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar ak orthosis), without knee joint, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":574.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86713","name":"Legionella antibody","description":"Antibody; legionella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51728","name":"Cystometrogram w/vp","description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4000","name":"Repl girdle milwaukee orth","description":"Replace girdle for spinal orthosis (ctlso or so)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":594.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87540","name":"Legion pneumo dna dir prob","description":"Infectious agent detection by nucleic acid (dna or rna); legionella pneumophila, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81320","name":"Plcg2 gene common variants","description":"Plcg2 (phospholipase c gamma 2) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, r665w, s707f, l845f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78453","name":"Ht muscle image planar sing","description":"Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61524","name":"Removal of brain lesion","description":"Craniectomy, infratentorial or posterior fossa; for excision or fenestration of cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32608","name":"Thoracoscopy w/bx nodule","description":"Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28820","name":"Amputation of toe","description":"Amputation, toe; metatarsophalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95868","name":"Ndl emg cranial nrv musc bi","description":"Needle electromyography; cranial nerve supplied muscles, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9901","name":"Delivery/set up/dispensing","description":"Dme delivery, set up, and/or dispensing service component of another hcpcs code","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36907","name":"Balo angiop ctr dialysis seg","description":"Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33970","name":"Aortic circulation assist","description":"Insertion of intra-aortic balloon assist device through the femoral artery, open approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27448","name":"Incision of thigh","description":"Osteotomy, femur, shaft or supracondylar; without fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":694.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38243","name":"Transplj hematopoietic boost","description":"Hematopoietic progenitor cell (hpc); hpc boost","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93280","name":"Pm device progr eval dual","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23078","name":"Rad rescj tum shoulder 5cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15774","name":"Gfrg autol fat lipo ea addl","description":"Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2750","name":"Anti-reflective coating","description":"Anti-reflective coating, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26860","name":"Fusion of finger joint","description":"Arthrodesis, interphalangeal joint, with or without internal fixation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83008","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4557","name":"Lead wires, pair","description":"Lead wires, (e.g., apnea monitor), per pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33977","name":"Remove ventricular device","description":"Removal of ventricular assist device; extracorporeal, single ventricle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":980.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83080","name":"Assay of b hexosaminidase ea","description":"B-hexosaminidase, each assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99606","name":"Mtms by pharm est 15 min","description":"Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, established patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7025","name":"Replace chest compress vest","description":"High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5655","name":"Socket insert below knee","description":"Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75665","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77321","name":"Special teletx port plan","description":"Special teletherapy port plan, particles, hemibody, total body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92996","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12052","name":"Intmd rpr face/mm 2.6-5.0 cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58925","name":"Removal of ovarian cyst(s)","description":"Ovarian cystectomy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":490.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94016","name":"Review patient spirometry","description":"Patient-initiated spirometric recording per 30-day period of time; review and interpretation only by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28615","name":"Repair foot dislocation","description":"Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78306","name":"Bone imaging whole body","description":"Bone and/or joint imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9537","name":"Tc99m mebrofenin","description":"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33870","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2129.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54700","name":"I&d epdidyms tstis&/scrot sp","description":"Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69610","name":"Tympanic membrane repair","description":"Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":305.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75630","name":"X-ray aorta leg arteries","description":"Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77332","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; simple (simple block, simple bolus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27424","name":"Revision/removal of kneecap","description":"Reconstruction of dislocating patella; with patellectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":631.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7503","name":"Hmes filter holder or cap","description":"Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5925","name":"Above knee manual lock","description":"Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33519","name":"Cabg artery-vein three","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92571","name":"Filtered speech test","description":"Filtered speech test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36254","name":"Ins cath ren art 2nd+ bilat","description":"Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, an","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21011","name":"Exc face les sc <2 cm","description":"Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16025","name":"Dress/debrid p-thick burn m","description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83915","name":"Assay of nucleotidase","description":"Nucleotidase 5-","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40804","name":"Removal foreign body mouth","description":"Removal of embedded foreign body, vestibule of mouth; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78473","name":"Gated heart multiple","description":"Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43645","name":"Lap gastr bypass incl smll i","description":"Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29883","name":"Arthrs kne srg mnisc rpr m&l","description":"Arthroscopy, knee, surgical; with meniscus repair (medial and lateral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":709.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27496","name":"Decompression of thigh/knee","description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94642","name":"Aerosol inhalation treatment","description":"Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0449T","name":"Insj aqueous drain dev 1st","description":"Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":489.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63064","name":"Decompress spinal cord thrc","description":"Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43846","name":"Gstr rstcv px shrt roux-en-y","description":"Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) roux-en-y gastroenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1357.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52000","name":"Cystourethroscopy","description":"Cystourethroscopy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0731","name":"Conductive garment for tens/","description":"Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patients skin by layers of fabric)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65730","name":"Corneal transplant","description":"Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4361","name":"Pneuma/vac walk boot pre ots","description":"Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51595","name":"Remove bladder/revise tract","description":"Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6211","name":"Foam drg > 48 sq in w/o brdr","description":"Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10180","name":"I&d complex po wound infctj","description":"Incision and drainage, complex, postoperative wound infection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99491","name":"Chrnc care mgmt phys 1st 30","description":"Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or funct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78205","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27734","name":"Repair lower leg epiphyses","description":"Arrest, epiphyseal (epiphysiodesis), open; distal tibia and fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":553.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57250","name":"Repair rectum & vagina","description":"Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33780","name":"Rpr tga rcnstj clsr vsd","description":"Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, jatene type); with closure of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2064.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82480","name":"Assay serum cholinesterase","description":"Cholinesterase; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32906","name":"Revise & repair chest wall","description":"Thoracoplasty, schede type or extrapleural (all stages); with closure of bronchopleural fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1320.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01484","name":"Anes opn lw l/a/f oste/ostpl","description":"Anesthesia for open procedures on bones of lower leg, ankle, and foot; osteotomy or osteoplasty of tibia and/or fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99468","name":"Neonate crit care initial","description":"Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81237","name":"Ezh2 gene common variants","description":"Ezh2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, diffuse large b-cell lymphoma) gene analysis, common variant(s) (eg, codon 646)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6605","name":"Single pivot hinge pair","description":"Upper extremity additions, single pivot hinge, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20704","name":"Mnl prep&insj i-artic rx dev","description":"Manual preparation and insertion of drug-delivery device(s), intra-articular (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94240","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64713","name":"Revision of arm nerve(s)","description":"Neuroplasty, major peripheral nerve, arm or leg, open; brachial plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":664.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82523","name":"Collagen crosslinks","description":"Collagen cross links, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22207","name":"Incis spine 3 column lumbar","description":"Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2107.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27828","name":"Treat lower leg fracture","description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1111.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45387","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":255.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27472","name":"Repair/graft of thigh","description":"Repair, nonunion or malunion, femur, distal to head and neck; with iliac or other autogenous bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77418","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":311.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99202","name":"Office o/p new sf 15 min","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 15 minutes must be met or exceede","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28750","name":"Fusion of big toe joint","description":"Arthrodesis, great toe; metatarsophalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":653.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15920","name":"Exc coccygl pr ulc prim sutr","description":"Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":409.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73060","name":"X-ray exam of humerus","description":"Radiologic examination; humerus, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27306","name":"Incision of thigh tendon","description":"Tenotomy, percutaneous, adductor or hamstring; single tendon (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24155","name":"Resection of elbow joint","description":"Resection of elbow joint (arthrectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72141","name":"Mri neck spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8624","name":"Lith ion batt cid, ear level","description":"Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0421","name":"Ed svc ckd grp per session","description":"Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6682","name":"Test sock elbw disart/above","description":"Upper extremity addition, test socket, elbow disarticulation or above elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22534","name":"Arthrd lat xtrcvtry tq ea ad","description":"Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99397","name":"Per pm reeval est pat 65+ yr","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 ye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24366","name":"Reconstruct head of radius","description":"Arthroplasty, radial head; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50695","name":"Plmt ureteral stent prq","description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, with separate nephrostomy catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82520","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0800","name":"Pov group 1 std up to 300lbs","description":"Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2795","name":"Knee control full kneecap","description":"Addition to lower extremity orthosis, knee control, full kneecap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98972","name":"Nqhp ol dig assmt&mgmt 21+","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37650","name":"Ligation of femoral vein","description":"Ligation of femoral vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28810","name":"Amputation toe & metatarsal","description":"Amputation, metatarsal, with toe, single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97750","name":"Physical performance test","description":"Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96203","name":"Mlt fam grp bhv train ea add","description":"Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of paren","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51820","name":"Revision of urinary tract","description":"Cystourethroplasty with unilateral or bilateral ureteroneocystostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":876.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4410","name":"Ost skn barr extnd >4 sq","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23331","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":441.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49041","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":759.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58270","name":"Vag hyst w/enterocele repair","description":"Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28114","name":"Removal of metatarsal heads","description":"Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, clayton type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":864.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49610","name":"Repair umbilical lesion","description":"Repair of omphalocele (gross type operation); first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49520","name":"Rerepair ing hernia reduce","description":"Repair recurrent inguinal hernia, any age; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":526.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1990","name":"Afo doub solid stirrup calf","description":"Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar bk orthosis), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88374","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20972","name":"Bone/skin graft metatarsal","description":"Free osteocutaneous flap with microvascular anastomosis; metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00214","name":"Anes icr px burr holes","description":"Anesthesia for intracranial procedures; burr holes, including ventriculography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35321","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; axillary-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21181","name":"Rcnst cntrg b9 tum crnl xtrc","description":"Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous dysplasia), extracranial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27538","name":"Treat knee fracture(s)","description":"Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54400","name":"Insert semi-rigid prosthesis","description":"Insertion of penile prosthesis; non-inflatable (semi-rigid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94726","name":"Plethysmography lung volumes","description":"Plethysmography for determination of lung volumes and, when performed, airway resistance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85421","name":"Fibrinolytic plasminogen","description":"Fibrinolytic factors and inhibitors; plasminogen, antigenic assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49083","name":"Abd paracentesis w/imaging","description":"Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":229.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21421","name":"Cltx palatal/max fx wire fix","description":"Closed treatment of palatal or maxillary fracture (lefort i type), with interdental wire fixation or fixation of denture or splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75774","name":"Artery x-ray each vessel","description":"Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57130","name":"Excision vaginal septum","description":"Excision of vaginal septum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8041","name":"Midfacial prosthesis","description":"Midfacial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","KM","95","93","NU","","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2521","name":"Cntct lens hydrophilic toric","description":"Contact lens, hydrophilic, toric, or prism ballast, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87380","name":"Hepatitis delta agent ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hepatitis, delta agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2621","name":"Wc planar back cush wd>=22in","description":"Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3455","name":"Shoe heel new leather standa","description":"Heel, new leather, standard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0044","name":"Ftrst upr hanger brac rep ea","description":"Footrest, upper hanger bracket, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5970","name":"Foot external keel sach foot","description":"All lower extremity prostheses, foot, external keel, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86235","name":"Nuclear antigen antibody","description":"Extractable nuclear antigen, antibody to, any method (eg, nrnp, ss-a, ss-b, sm, rnp, sc170, j01), each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33917","name":"Repair pulmonary artery","description":"Repair of pulmonary artery stenosis by reconstruction with patch or graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93571","name":"Iv dop vel&/press c flo 1st","description":"Intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, when performed; initial vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27648","name":"Injection for ankle x-ray","description":"Injection procedure for ankle arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42210","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":875.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61781","name":"Scan proc cranial intra","description":"Stereotactic computer-assisted (navigational) procedure; cranial, intradural (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64876","name":"Repair nerve/shorten bone","description":"Suture of nerve; requiring shortening of bone of extremity (list separately in addition to code for nerve suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27641","name":"Partial removal of fibula","description":"Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64804","name":"Sympathectomy cervicothorac","description":"Sympathectomy, cervicothoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61120","name":"Burr hole for ventr puncture","description":"Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":674.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93793","name":"Anticoag mgmt pt warfarin","description":"Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (inr) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45378","name":"Diagnostic colonoscopy","description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25450","name":"Epiphysl arrst dstl rds/ulna","description":"Epiphyseal arrest by epiphysiodesis or stapling; distal radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72114","name":"X-ray exam l-s spine bending","description":"Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93653","name":"Compre ep eval tx svt","description":"Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensiona","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":892.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70015","name":"Contrast x-ray of brain","description":"Cisternography, positive contrast, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81002","name":"Urinalysis nonauto w/o scope","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","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2090","name":"Hkafo unilat torsion ball br","description":"Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0830","name":"Halo cerv into milwaukee typ","description":"Halo procedure, cervical halo incorporated into milwaukee type orthosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43600","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67113","name":"Repair retinal detach cplx","description":"Repair of complex retinal detachment (eg, proliferative vitreoretinopathy, stage c-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, including, when performed, air, gas, or silicone oil tamp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82941","name":"Assay of gastrin","description":"Gastrin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41018","name":"Drainage of mouth lesion","description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; masticator space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31623","name":"Dx bronchoscope/brush","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0412","name":"Open tx iliac spine uni/bil","description":"Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":473.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0825","name":"Pwc gp 2 hd cap chair","description":"Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25810","name":"Arthrd wrst iliac/oth agrft","description":"Arthrodesis, wrist; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":725.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93786","name":"Ambl bp mntr w/sw rec only","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; recording only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26075","name":"Explore/treat finger joint","description":"Arthrotomy, with exploration, drainage, or removal of loose or foreign body; metacarpophalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22103","name":"Remove extra spine segment","description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35251","name":"Rpr blvsl vn grf intra-abdl","description":"Repair blood vessel with vein graft; intra-abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1526.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43194","name":"Esophagoscp rig trnso rem fb","description":"Esophagoscopy, rigid, transoral; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0504","name":"Pwr adpt pneum vad, rep veh","description":"Power adapter for pneumatic ventricular assist device, replacement only, vehicle type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0961","name":"Wheelchair brake extension","description":"Manual wheelchair accessory, wheel lock brake extension (handle), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27727","name":"Repair of lower leg","description":"Repair of congenital pseudarthrosis, tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":877.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63001","name":"Remove spine lamina 1/2 crvl","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1112.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27339","name":"Exc thigh/knee tum dep 5cm/>","description":"Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":645.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43420","name":"Repair esophagus opening","description":"Closure of esophagostomy or fistula; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":788.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45379","name":"Colonoscopy w/fb removal","description":"Colonoscopy, flexible; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11302","name":"Shave skin lesion 1.1-2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4918","name":"Venous pressure clamp","description":"Venous pressure clamp, for hemodialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2770","name":"Occluder lens/es","description":"Occluder lens, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64633","name":"Destroy cerv/thor facet jnt","description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); cervical or thoracic, single facet joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77385","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":311.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89190","name":"Nasal smear for eosinophils","description":"Nasal smear for eosinophils","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27466","name":"Lengthening of thigh bone","description":"Osteoplasty, femur; lengthening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37248","name":"Trluml balo angiop 1st vein","description":"Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":751.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22523","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5883.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76010","name":"X-ray nose to rectum","description":"Radiologic examination from nose to rectum for foreign body, single view, child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15922","name":"Exc coccygl pr ulc flap clsr","description":"Excision, coccygeal pressure ulcer, with coccygectomy; with flap closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27256","name":"Treat hip dislocation","description":"Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":257.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58350","name":"Reopen fallopian tube","description":"Chromotubation of oviduct, including materials","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11982","name":"Remove drug implant device","description":"Removal, non-biodegradable drug delivery implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00561","name":"Anes px heart w/pump<1 yr","description":"Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35587","name":"Vein byp pop-tibl peroneal","description":"In-situ vein bypass; popliteal-tibial, peroneal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42300","name":"Drainage of salivary gland","description":"Drainage of abscess; parotid, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31590","name":"Reinnervate larynx","description":"Laryngeal reinnervation by neuromuscular pedicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46040","name":"I&d ischiorct&/perirct absc","description":"Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31231","name":"Nasal endoscopy dx","description":"Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93701","name":"Bioimpedance cv analysis","description":"Bioimpedance-derived physiologic cardiovascular analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56810","name":"Perineoplasty rpr per nonob","description":"Perineoplasty, repair of perineum, nonobstetrical (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52007","name":"Cysto urtrl cathj brush bx","description":"Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60605","name":"Remove carotid body lesion","description":"Excision of carotid body tumor; with excision of carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1464.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85610","name":"Prothrombin time","description":"Prothrombin time;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88283","name":"Chromosome banding study","description":"Chromosome analysis; additional specialized banding technique (eg, nor, c-banding)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72081","name":"X-ray exam entire spi 1 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33915","name":"Remove lung artery emboli","description":"Pulmonary artery embolectomy; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1194.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35701","name":"Expl n/flwd surg neck art","description":"Exploration not followed by surgical repair, artery; neck (eg, carotid, subclavian)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":366.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77080","name":"Dxa bone density axial","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10004","name":"Fna bx w/o img gdn ea addl","description":"Fine needle aspiration biopsy, without imaging guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5626","name":"Test socket hip disarticulat","description":"Addition to lower extremity, test socket, hip disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":237.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82143","name":"Amniotic fluid scan","description":"Amniotic fluid scan (spectrophotometric)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9157","name":"Transesoph doppl cardiac mon","description":"Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5990","name":"User adjustable heel height","description":"Addition to lower extremity prosthesis, user adjustable heel height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":884.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7017","name":"Nebulizer not used w oxygen","description":"Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00529","name":"Anes clsd ch mediast&thrc w/","description":"Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27676","name":"Repair lower leg tendons","description":"Repair, dislocating peroneal tendons; with fibular osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":494.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67505","name":"Inject/treat eye socket","description":"Retrobulbar injection; alcohol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97130","name":"Ther ivntj ea addl 15 min","description":"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2540","name":"Thigh/wght bear lacer molded","description":"Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36247","name":"Ins cath abd/l-ext art 3rd","description":"Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52276","name":"Cystoscopy and treatment","description":"Cystourethroscopy with direct vision internal urethrotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24138","name":"Sequestrectomy olecrn proces","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90952","name":"Esrd serv 2-3 vsts p mo <2yr","description":"End-stage renal disease (esrd) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00540","name":"Anes thoracotomy px nos","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87804","name":"Influenza assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; influenza","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35512","name":"Art byp grft subclav-brchial","description":"Bypass graft, with vein; subclavian-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1064.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0247","name":"Routine footcare pt w lops","description":"Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wou","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23400","name":"Fixation of shoulder blade","description":"Scapulopexy (eg, sprengels deformity or for paralysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0071","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51080","name":"Drainage of bladder abscess","description":"Drainage of perivesical or prevesical space abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82370","name":"X-ray assay calculus","description":"Calculus; x-ray diffraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20693","name":"Adjmt/revj ext fixj sys anes","description":"Adjustment or revision of external fixation system requiring anesthesia (eg, new pin[s] or wire[s] and/or new ring[s] or bar[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58345","name":"Reopen fallopian tube","description":"Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87498","name":"Enterovirus probe&revrs trns","description":"Infectious agent detection by nucleic acid (dna or rna); enterovirus, amplified probe technique, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2381","name":"Pneum drive wheel tire","description":"Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8612","name":"Aqueous shunt prosthesis","description":"Aqueous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82042","name":"Other source albumin quan ea","description":"Albumin; other source, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64461","name":"Pvb thoracic single inj site","description":"Paravertebral block (pvb) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42831","name":"Removal of adenoids","description":"Adenoidectomy, primary; age 12 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70160","name":"X-ray exam of nasal bones","description":"Radiologic examination, nasal bones, complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95864","name":"Needle emg 4 extremities","description":"Needle electromyography; 4 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26555","name":"Positional change of finger","description":"Transfer, finger to another position without microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0356T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49540","name":"Repair lumbar hernia","description":"Repair lumbar hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":560.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6698","name":"Add up-ex prosthes lock mech","description":"Addition to upper extremity prosthesis, lock mechanism, excludes socket insert","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35549","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1351.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97607","name":"Neg prs wnd thr ndme<=50sqcm","description":"Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surfac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84481","name":"Free assay (ft-3)","description":"Triiodothyronine t3; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67835","name":"Revise eyelashes","description":"Correction of trichiasis; incision of lid margin, with free mucous membrane graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16030","name":"Dress/debrid p-thick burn l","description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than 1 extremity, or greater than 10% total body surface area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87535","name":"Hiv-1 probe&reverse trnscrpj","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-1, amplified probe technique, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52000","name":"Cystourethroscopy","description":"Cystourethroscopy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75710","name":"Artery x-rays arm/leg","description":"Angiography, extremity, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54328","name":"Revise penis/urethra","description":"1-stage distal hypospadias repair (with or without chordee or circumcision); with extensive dissection to correct chordee and urethroplasty with local skin flaps, skin graft patch, and/or island flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":758.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28047","name":"Resect foot/toe tumor 3 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":858.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3908","name":"Who cock-up nonmolde pre ots","description":"Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0426","name":"Inpt/ed teleconsult50","description":"Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41120","name":"Partial removal of tongue","description":"Glossectomy; less than one-half tongue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73503","name":"X-ray exam hip uni 4/> views","description":"Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0780","name":"Mech amb infusion pump <8hrs","description":"Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20661","name":"Application halo cranial","description":"Application of halo, including removal; cranial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9868","name":"Cmmi asyntelehealth <10min","description":"Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67110","name":"Repair detached retina","description":"Repair of retinal detachment; by injection of air or other gas (eg, pneumatic retinopexy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":535.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29807","name":"Sho arthrs srg rpr slap les","description":"Arthroscopy, shoulder, surgical; repair of slap lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58800","name":"Drainage of ovarian cyst(s)","description":"Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":219.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35583","name":"Vein byp grft fem-popliteal","description":"In-situ vein bypass; femoral-popliteal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35587","name":"Vein byp pop-tibl peroneal","description":"In-situ vein bypass; popliteal-tibial, peroneal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1203.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87650","name":"Strep a dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); streptococcus, group a, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62367","name":"Analyze spine infus pump","description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming or refill","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5131","name":"Appliance cleaner","description":"Appliance cleaner, incontinence and ostomy appliances, per 16 oz.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2710","name":"Glass/plastic slab off prism","description":"Slab off prism, glass or plastic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21800","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15421","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49501","name":"Rpr ing hernia init blocked","description":"Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1240","name":"Lumbar derotation pad","description":"Addition to tlso, (low profile), lumbar derotation pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93565","name":"Njx car cth slctv lv/la ang","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective left ventricular or left atrial angiography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0855","name":"Pwc gp 3 xhd cap chair","description":"Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28226","name":"Release of foot tendons","description":"Tenolysis, extensor, foot; multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53442","name":"Remove/revise male sling","description":"Removal or revision of sling for male urinary incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92015","name":"Determine refractive state","description":"Determination of refractive state","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93463","name":"Drug admin & hemodynmic meas","description":"Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (list separately in addition to","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82143","name":"Amniotic fluid scan","description":"Amniotic fluid scan (spectrophotometric)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29020","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78434","name":"Aqmbf pet rest & rx stress","description":"Absolute quantitation of myocardial blood flow (aqmbf), positron emission tomography (pet), rest and pharmacologic stress (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4625","name":"Trach care kit for new trach","description":"Tracheostomy care kit for new tracheostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33521","name":"Cabg artery-vein four","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":571.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27332","name":"Removal of knee cartilage","description":"Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial or lateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01744","name":"Anes opn/arthrs elbw rpr hum","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; repair of nonunion or malunion of humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31292","name":"Nsl/sins ndsc med/inf dcmprn","description":"Nasal/sinus endoscopy, surgical, with orbital decompression; medial or inferior wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":745.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36576","name":"Repair tunneled cv cath","description":"Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96137","name":"Psycl/nrpsyc tst phy/qhp ea","description":"Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11056","name":"Parng/cutg b9 hyprkr les 2-4","description":"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57112","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1167.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49013","name":"Prpertl pel pack hemrrg trma","description":"Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma, including local exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45136","name":"Excise ileoanal reservior","description":"Excision of ileoanal reservoir with ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33993","name":"Reposg perq r/l hrt vad","description":"Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36906","name":"Thrmbc/nfs dialysis circuit","description":"Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thromboly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3182.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76098","name":"X-ray exam surgical specimen","description":"Radiological examination, surgical specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6697","name":"Cus elbo skt in not con/atyp","description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31576","name":"Laryngoscopy with biopsy","description":"Laryngoscopy, flexible; with biopsy(ies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62147","name":"Crnop w/autograft>5 cm diam","description":"Cranioplasty with autograft (includes obtaining bone grafts); larger than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1276.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88374","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0483","name":"Monitor elec vad, rep","description":"Monitor/display module for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9131.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86619","name":"Borrelia antibody","description":"Antibody; borrelia (relapsing fever)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64454","name":"Njx aa&/strd gnclr nrv brnch","description":"Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49600","name":"Repair umbilical lesion","description":"Repair of small omphalocele, with primary closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31390","name":"Removal of larynx & pharynx","description":"Pharyngolaryngectomy, with radical neck dissection; without reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45380","name":"Colonoscopy and biopsy","description":"Colonoscopy, flexible; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52332","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with insertion of indwelling ureteral stent (eg, gibbons or double-j type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74170","name":"Ct abd wo cntrst flwd cntrst","description":"Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12032","name":"Intmd rpr s/a/t/ext 2.6-7.5","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2614","name":"Position back cush wd>=22in","description":"Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92270","name":"Electro-oculography w/i&r","description":"Electro-oculography with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87631","name":"Resp virus 3-5 targets","description":"Infectious agent detection by nucleic acid (dna or rna); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9986","name":"Remote e/m est. pt 40mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63301","name":"Remove vert xdrl body thrc","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1084","name":"Hemi-wheelchair detachable a","description":"Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31075","name":"Exploration of frontal sinus","description":"Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, lynch type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93461","name":"R&l hrt art/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, cath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1450.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64630","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent; pudendal nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78494","name":"Heart image spect","description":"Cardiac blood pool imaging, gated equilibrium, spect, at rest, wall motion study plus ejection fraction, with or without quantitative processing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2210","name":"Wheelchair bearings","description":"Wheelchair accessory, bearings, any type, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35511","name":"Art byp grft subclav-subclav","description":"Bypass graft, with vein; subclavian-subclavian","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":989.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0958","name":"Whlchr att- conv 1 arm drive","description":"Manual wheelchair accessory, one-arm drive attachment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27422","name":"Revision of unstable kneecap","description":"Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, campbell, goldwaite type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":627.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86701","name":"Hiv-1antibody","description":"Antibody; hiv-1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0484","name":"Tlso rigid plastic cust fab","description":"Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by ov","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":886.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47505","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0822","name":"Pwc gp 2 std seat/back","description":"Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31634","name":"Bronch w/balloon occlusion","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (eg, fibrin glue), if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1282.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67331","name":"Eye surgery follow-up add-on","description":"Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82104","name":"Alpha-1-antitrypsin pheno","description":"Alpha-1-antitrypsin; phenotype","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00942","name":"Anes vag px clptmy vgnc clpr","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); colpotomy, vaginectomy, colporrhaphy, and open urethral procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44340","name":"Revision of colostomy","description":"Revision of colostomy; simple (release of superficial scar) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":508.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77762","name":"Apply intrcav radiat interm","description":"Intracavitary radiation source application; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1270","name":"Abdominal pad","description":"Addition to tlso, (low profile), abdominal pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75803","name":"Lymph vessel x-ray arms/legs","description":"Lymphangiography, extremity only, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86922","name":"Compatibility test antiglob","description":"Compatibility test each unit; antiglobulin technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21080","name":"Impres&prep def obt prosth","description":"Impression and custom preparation; definitive obturator prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1381.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8642","name":"Hallux implant","description":"Hallux implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73522","name":"X-ray exam hips bi 3-4 views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58805","name":"Drainage of ovarian cyst(s)","description":"Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44140","name":"Partial removal of colon","description":"Colectomy, partial; with anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36262","name":"Removal of infusion pump","description":"Removal of implanted intra-arterial infusion pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78072","name":"Parathyrd planar w/spect&ct","description":"Parathyroid planar imaging (including subtraction, when performed); with tomographic (spect), and concurrently acquired computed tomography (ct) for anatomical localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31622","name":"Dx bronchoscope/wash","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31661","name":"Bronch thermoplsty 2/> lobes","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24505","name":"Cltx humrl shft fx w/mnpj","description":"Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5051","name":"Pouch clsd w barr attached","description":"Ostomy pouch, closed; with barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2200","name":"Lens spher bifoc plano 4.00d","description":"Sphere, bifocal, plano to plus or minus 4.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85475","name":"Hemolysin acid","description":"Hemolysin, acid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32607","name":"Thoracoscopy w/bx infiltrate","description":"Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43886","name":"Gstr rstcv px opn revj port","description":"Gastric restrictive procedure, open; revision of subcutaneous port component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0310","name":"Immunize counsel 5-15 min","description":"Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":261.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5230","name":"Fem focal defic constant fri","description":"Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1887.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96136","name":"Psycl/nrpsyc tst phy/qhp 1st","description":"Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44133","name":"Enterectomy live donor","description":"Donor enterectomy (including cold preservation), open; partial, from living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":725.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87350","name":"Hepatitis be ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hepatitis be antigen (hbeag)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20560","name":"Ndl insj w/o njx 1 or 2 musc","description":"Needle insertion(s) without injection(s); 1 or 2 muscle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2392","name":"Solid caster tire, integrate","description":"Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0080","name":"Care manag h vst new pt 75 m","description":"Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29828","name":"Sho arthrs srg bicp tenodsis","description":"Arthroscopy, shoulder, surgical; biceps tenodesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61215","name":"Ins subq rsvr pmp/nfs sys","description":"Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61705","name":"Revise circulation to head","description":"Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial and cervical occlusion of carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2395.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46930","name":"Destroy internal hemorrhoids","description":"Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90474","name":"Immune admin oral/nasal addl","description":"Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70150","name":"X-ray exam of facial bones","description":"Radiologic examination, facial bones; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72131","name":"Ct lumbar spine w/o dye","description":"Computed tomography, lumbar spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15951","name":"Exc trchntr pr ulc ostc","description":"Excision, trochanteric pressure ulcer, with primary suture; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":571.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33217","name":"Insert 2 electrode pm-defib","description":"Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50526","name":"Close nephrovisceral fistula","description":"Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56515","name":"Destroy vulva lesion/s compl","description":"Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64445","name":"Njx aa&/strd sciatic nrv img","description":"Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87557","name":"M.tuberculo dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria tuberculosis, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9987","name":"Bpci advanced in home visit","description":"Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/am","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17312","name":"Mohs addl stage","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), h","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49324","name":"Lap insert tunnel ip cath","description":"Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61156","name":"Burr hol aspir hmtm/cst icer","description":"Burr hole(s); with aspiration of hematoma or cyst, intracerebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38300","name":"Drainage lymph node lesion","description":"Drainage of lymph node abscess or lymphadenitis; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":211.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19370","name":"Revj peri-implt capsule brst","description":"Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":443.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92228","name":"Img rta detc/mntr ds phy/qhp","description":"Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64400","name":"Njx aa&/strd trigeminal nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78645","name":"Csf shunt evaluation","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92275","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4580","name":"Cast supplies (plaster)","description":"Cast supplies (e.g., plaster)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76705","name":"Echo exam of abdomen","description":"Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88162","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4326","name":"Male external catheter","description":"Male external catheter with integral collection chamber, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00840","name":"Anes iper px lower abd nos","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12002","name":"Rpr s/n/ax/gen/trnk2.6-7.5cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G9044","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86695","name":"Herpes simplex type 1 test","description":"Antibody; herpes simplex, type 1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50951","name":"Endoscopy of ureter","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45389","name":"Colonoscopy w/stent plcmt","description":"Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":223.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26010","name":"Drainage of finger abscess","description":"Drainage of finger abscess; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36000","name":"Place needle in vein","description":"Introduction of needle or intracatheter, vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93621","name":"Comp ep evl l pac&rec c sins","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15833","name":"Exc excessive skin leg","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":561.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6541","name":"Gc stocking waistlngth 40+","description":"Gradient compression stocking, waist length, 40 mmhg or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92370","name":"Rpr&refitg spect xcp aphakia","description":"Repair and refitting spectacles; except for aphakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31766","name":"Carinal reconstruction","description":"Carinal reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75954","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7362","name":"Battery chrgr six volt otto","description":"Battery charger, six volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24366","name":"Reconstruct head of radius","description":"Arthroplasty, radial head; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":575.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47534","name":"Plmt biliary drainage cath","description":"Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1093.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26518","name":"Fusion of knuckle joints","description":"Capsulodesis, metacarpophalangeal joint; 3 or 4 digits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92287","name":"Ant sgm img ir flrscn angrph","description":"Anterior segment imaging with interpretation and report; with fluorescein angiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2218","name":"Lens aniseikonic bifocal","description":"Aniseikonic, per lens, bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31750","name":"Tracheoplasty cervical","description":"Tracheoplasty; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28490","name":"Treat big toe fracture","description":"Closed treatment of fracture great toe, phalanx or phalanges; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6257","name":"Transparent film <= 16 sq in","description":"Transparent film, sterile, 16 sq. in. or less, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21431","name":"Cltx craniofacial separation","description":"Closed treatment of craniofacial separation (lefort iii type) using interdental wire fixation of denture or splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96422","name":"Chemo ia infusion up to 1 hr","description":"Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31259","name":"Nsl/sins ndsc sphn tiss rmvl","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":355.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0425","name":"Inpt/ed teleconsult30","description":"Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61605","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0014","name":"Alcohol and/or drug services","description":"Alcohol and/or drug services; ambulatory detoxification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57156","name":"Ins vag brachytx device","description":"Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2718","name":"Fresnell prism press-on lens","description":"Press-on lens, fresnell prism, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58150","name":"Total hysterectomy","description":"Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":647.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2101","name":"Single visn sphere 4.12-7.00","description":"Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31030","name":"Exploration maxillary sinus","description":"Sinusotomy, maxillary (antrotomy); radical (caldwell-luc) without removal of antrochoanal polyps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97129","name":"Ther ivntj 1st 15 min","description":"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95966","name":"Meg evoked single","description":"Magnetoencephalography (meg), recording and analysis; for evoked magnetic fields, single modality (eg, sensory, motor, language, or visual cortex localization)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27355","name":"Remove femur lesion","description":"Excision or curettage of bone cyst or benign tumor of femur;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2312","name":"Lens sphc trifo 7.25-12/2.25","description":"Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0069","name":"Rr whl compl sol tire rep ea","description":"Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82746","name":"Assay of folic acid serum","description":"Folic acid; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52214","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83630","name":"Lactoferrin fecal (qual)","description":"Lactoferrin, fecal; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61597","name":"Transcondylar approach/skull","description":"Transcondylar (far lateral) approach to posterior cranial fossa, jugular foramen or midline skull base, including occipital condylectomy, mastoidectomy, resection of c1-c3 vertebral body(s), decompression of vertebral artery, with or without mobilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4380","name":"Urinary rubber pouch w fcplt","description":"Ostomy pouch, urinary, with faceplate attached, rubber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25310","name":"Transplant forearm tendon","description":"Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":516.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11310","name":"Shave skin lesion 0.5 cm/<","description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87075","name":"Cultr bacteria except blood","description":"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81190","name":"Cstb gene known famil vrnt","description":"Cstb (cystatin b) (eg, unverricht-lundborg disease) gene analysis; known familial variant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98960","name":"Edu&trn pt self-mgmt nqhp 1","description":"Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21044","name":"Removal of jaw bone lesion","description":"Excision of malignant tumor of mandible;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":702.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87581","name":"M.pneumon dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycoplasma pneumoniae, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76801","name":"Ob us < 14 wks single fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33822","name":"Repair pda div<18 years","description":"Repair of patent ductus arteriosus; by division, younger than 18 years","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":884.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73092","name":"X-ray exam of arm infant","description":"Radiologic examination; upper extremity, infant, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75680","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":285.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22858","name":"Tot disc arthrp 2nd lvl crv","description":"Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0271","name":"Mattress innerspring","description":"Mattress, innerspring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8914","name":"Mra w/o fol w/cont, lwr ext","description":"Magnetic resonance angiography without contrast followed by with contrast, lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83735","name":"Assay of magnesium","description":"Magnesium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4180","name":"Parenteral sol carb > 50%","description":"Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95966","name":"Meg evoked single","description":"Magnetoencephalography (meg), recording and analysis; for evoked magnetic fields, single modality (eg, sensory, motor, language, or visual cortex localization)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11107","name":"Incal bx skn ea sep/addl","description":"Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43236","name":"Uppr gi scope w/submuc inj","description":"Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6407","name":"Packing strips, non-impreg","description":"Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54435","name":"Revision of penis","description":"Corpora cavernosa-glans penis fistulization (eg, biopsy needle, winter procedure, rongeur, or punch) for priapism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37227","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7249.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50320","name":"Remove kidney living donor","description":"Donor nephrectomy (including cold preservation); open, from living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1310.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80195","name":"Assay of sirolimus","description":"Sirolimus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7030","name":"Cpap full face mask","description":"Full face mask used with positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78291","name":"Pertl-ven shunt patency test","description":"Peritoneal-venous shunt patency test (eg, for leveen, denver shunt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29806","name":"Sho arthrs srg capsulorraphy","description":"Arthroscopy, shoulder, surgical; capsulorrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58301","name":"Remove intrauterine device","description":"Removal of intrauterine device (iud)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95921","name":"Autonomic nrv parasym inervj","description":"Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded r-r interval, valsalva ratio, and 30:15 ratio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23935","name":"Inc dp opn b1 crtx hum/elbw","description":"Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), humerus or elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29055","name":"Appl cast shoulder spica","description":"Application, cast; shoulder spica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4541","name":"Large disposable underpad","description":"Incontinence product, disposable underpad, large, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75564","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":840.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11402","name":"Exc tr-ext b9+marg 1.1-2 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4290","name":"Sacral nerve stim test lead","description":"Sacral nerve stimulation test lead, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41252","name":"Repair tongue laceration","description":"Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21142","name":"Rcnstj midface lefort i 2pcs","description":"Reconstruction midface, lefort i; 2 pieces, segment movement in any direction, without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50815","name":"Urine shunt to intestine","description":"Ureterocolon conduit, including intestine anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":990.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50075","name":"Nl rmvl lg staghorn calculus","description":"Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51980","name":"Construct bladder opening","description":"Cutaneous vesicostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":576.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84591","name":"Assay of nos vitamin","description":"Vitamin, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87517","name":"Hepatitis b dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis b virus, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52005","name":"Cysto w/urtrl cathj","description":"Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40843","name":"Reconstruction of mouth","description":"Vestibuloplasty; posterior, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86340","name":"Intrinsic factor antibody","description":"Intrinsic factor antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81310","name":"Npm1 gene","description":"Npm1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, exon 12 variants","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33980","name":"Remove intracorporeal device","description":"Removal of ventricular assist device, implantable intracorporeal, single ventricle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47010","name":"Hepatot opn drg absc/cst 1/2","description":"Hepatotomy, for open drainage of abscess or cyst, 1 or 2 stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1005.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54520","name":"Removal of testis","description":"Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21685","name":"Hyoid myotomy & suspension","description":"Hyoid myotomy and suspension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82938","name":"Gastrin test","description":"Gastrin after secretin stimulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66030","name":"Injection treatment of eye","description":"Injection, anterior chamber of eye (separate procedure); medication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62305","name":"Myelography lumbar injection","description":"Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":221.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64876","name":"Repair nerve/shorten bone","description":"Suture of nerve; requiring shortening of bone of extremity (list separately in addition to code for nerve suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87390","name":"Hiv-1 ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hiv-1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31576","name":"Laryngoscopy with biopsy","description":"Laryngoscopy, flexible; with biopsy(ies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84377","name":"Sugars multiple qual","description":"Sugars (mono-, di-, and oligosaccharides); multiple qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31084","name":"Removal of frontal sinus","description":"Sinusotomy frontal; obliterative, with osteoplastic flap, brow incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":879.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66174","name":"Trluml dil aq o/f can w/o st","description":"Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0636","name":"Pt support & positioning sys","description":"Multipositional patient support system, with integrated lift, patient accessible controls","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27057","name":"Buttock fasciotomy w/dbrdmt","description":"Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle) with debridement of nonviable muscle, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":858.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29906","name":"Subtalar arthro w/deb","description":"Arthroscopy, subtalar joint, surgical; with debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7027","name":"Combination oral/nasal mask","description":"Combination oral/nasal mask, used with continuous positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15115","name":"Epdrm agrft f/s/n/h/f/g/m 1","description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30220","name":"Insert nasal septal button","description":"Insertion, nasal septal prosthesis (button)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74301","name":"X-rays at surgery add-on","description":"Cholangiography and/or pancreatography; additional set intraoperative, radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85370","name":"Fibrinogen test","description":"Fibrin(ogen) degradation (split) products (fdp) (fsp); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8510","name":"Voice amplifier","description":"Voice amplifier","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50900","name":"Repair of ureter","description":"Ureterorrhaphy, suture of ureter (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89310","name":"Semen analysis w/count","description":"Semen analysis; motility and count (not including huhner test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00800","name":"Anes px lwr ant abdl wal nos","description":"Anesthesia for procedures on lower anterior abdominal wall; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31090","name":"Exploration of sinuses","description":"Sinusotomy, unilateral, 3 or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45303","name":"Proctosigmoidoscopy dilate","description":"Proctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire, bougie)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":740.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73218","name":"Mri upper extremity w/o dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93888","name":"Intracranial limited study","description":"Transcranial doppler study of the intracranial arteries; limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15956","name":"Exc trchntr pr ulc prep flap","description":"Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1650","name":"Ho abduction hip adjustable","description":"Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2580","name":"Pelvic control pelvic sling","description":"Addition to lower extremity, pelvic control, pelvic sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36481","name":"Insertion of catheter vein","description":"Percutaneous portal vein catheterization by any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43227","name":"Esophagoscopy control bleed","description":"Esophagoscopy, flexible, transoral; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":478.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87581","name":"M.pneumon dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycoplasma pneumoniae, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33330","name":"Insert major vessel graft","description":"Insertion of graft, aorta or great vessels; without shunt, or cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12005","name":"Rpr s/n/a/gen/trk12.6-20.0cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19086","name":"Bx breast add lesion mr imag","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":453.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12001","name":"Rpr s/n/ax/gen/trnk 2.5cm/<","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99292","name":"Critical care addl 30 min","description":"Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97028","name":"Ultraviolet therapy","description":"Application of a modality to 1 or more areas; ultraviolet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27745","name":"Reinforce tibia","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22870","name":"Insj stablj dev w/o dcmprn","description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92653","name":"Aep neurodiagnostic i&r","description":"Auditory evoked potentials; neurodiagnostic, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2329","name":"Head control nonproportional","description":"Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1270","name":"Wheelchair lightweight leg r","description":"Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0202","name":"Phototherapy light w/ photom","description":"Phototherapy (bilirubin) light with photometer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0143","name":"Scr c/v cyto,thinlayer,rescr","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11441","name":"Exc face-mm b9+marg 0.6-1 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22633","name":"Arthrd cmbn 1ntrspc lumbar","description":"Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27503","name":"Treatment of thigh fracture","description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":676.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78121","name":"Red cell mass multiple","description":"Red cell volume determination (separate procedure); multiple samplings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84437","name":"Assay of neonatal thyroxine","description":"Thyroxine; requiring elution (eg, neonatal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87177","name":"Ova and parasites smears","description":"Ova and parasites, direct smears, concentration and identification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71555","name":"Mri angio chest w or w/o dye","description":"Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35535","name":"Art byp grft hepatorenal","description":"Bypass graft, with vein; hepatorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83021","name":"Hemoglobin chromotography","description":"Hemoglobin fractionation and quantitation; chromatography (eg, a2, s, c, and/or f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37233","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":632.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1296","name":"Wheelchair special seat heig","description":"Special wheelchair seat height from floor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01999","name":"Unlisted anes procedure","description":"Unlisted anesthesia procedure(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50940","name":"Release of ureter","description":"Deligation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":717.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58950","name":"Resect ovarian malignancy","description":"Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61608","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; intradural, including dural repair, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2956.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57111","name":"Vagnc compl rmvl paravag tis","description":"Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24362","name":"Reconstruct elbow joint","description":"Arthroplasty, elbow; with implant and fascia lata ligament reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57285","name":"Repair paravag defect vag","description":"Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52234","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; small bladder tumor(s) (0.5 up to 2.0 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31370","name":"Partial removal of larynx","description":"Partial laryngectomy (hemilaryngectomy); horizontal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1543.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59350","name":"Repair of uterus","description":"Hysterorrhaphy of ruptured uterus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43241","name":"Egd tube/cath insertion","description":"Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00754","name":"Anes hrna rpr omphalocele","description":"Anesthesia for hernia repairs in upper abdomen; omphalocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43770","name":"Lap place gastr adj device","description":"Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":941.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5505","name":"Diab shoe w/metatarsal bar","description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92325","name":"Modification of contact lens","description":"Modification of contact lens (separate procedure), with medical supervision of adaptation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4423","name":"Ost pch for bar w lk fl/fltr","description":"Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99391","name":"Per pm reeval est pat infant","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6055","name":"Wrst mold sock w/exp interfa","description":"Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1433.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52601","name":"Prostatectomy (turp)","description":"Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69714","name":"Impl oi implt skull perq esp","description":"Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2616","name":"Pos back post/lat wdth>=22in","description":"Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78300","name":"Bone imaging limited area","description":"Bone and/or joint imaging; limited area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10008","name":"Fna bx w/fluor gdn ea addl","description":"Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77293","name":"Respirator motion mgmt simul","description":"Respiratory motion management simulation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94680","name":"O2 uptk rst&xers dir simple","description":"Oxygen uptake, expired gas analysis; rest and exercise, direct, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99157","name":"Mod sed other phys/qhp ea","description":"Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time (list separate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61700","name":"Brain aneurysm repr simple","description":"Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3145.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2500","name":"Contact lens pmma spherical","description":"Contact lens, pmma, spherical, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34705","name":"Evac rpr a-biiliac ndgft","description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71023","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87428","name":"Sarscov & inf vir a&b ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, sars-cov, s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27006","name":"Tenotomy abductor&/xtnsr hip","description":"Tenotomy, abductors and/or extensor(s) of hip, open (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98981","name":"Rtm tx mgmt ea addl 20 min","description":"Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; each additional 20 minutes (list separately in","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47532","name":"Injection for cholangiogram","description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; new access (eg, percutaneous transhepatic cholangiogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":650.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81305","name":"Myd88 gene p.leu265pro vrnt","description":"Myd88 (myeloid differentiation primary response 88) (eg, waldenstroms macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.leu265pro (l265p) variant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64736","name":"Incision of chin nerve","description":"Transection or avulsion of; mental nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87503","name":"Influenza dna amp prob addl","description":"Infectious agent detection by nucleic acid (dna or rna); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (list separately in addition to code","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6020","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33745","name":"Tis cgen car anomal 1st shnt","description":"Transcatheter intracardiac shunt (tis) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":917.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58410","name":"Suspension of uterus","description":"Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; with presacral sympathectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":521.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46942","name":"Treatment of anal fissure","description":"Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01932","name":"Anes th ivnt rad ntrthrc/jug","description":"Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intrathoracic or jugular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6207","name":"Contact layer >16<= 48 sq in","description":"Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87267","name":"Enterovirus antibody dfa","description":"Infectious agent antigen detection by immunofluorescent technique; enterovirus, direct fluorescent antibody (dfa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84238","name":"Assay nonendocrine receptor","description":"Receptor assay; non-endocrine (specify receptor)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95907","name":"Nvr cndj tst 1-2 studies","description":"Nerve conduction studies; 1-2 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42160","name":"Treatment mouth roof lesion","description":"Destruction of lesion, palate or uvula (thermal, cryo or chemical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2620","name":"Wc planar back cush wd <22in","description":"Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36556","name":"Insert non-tunnel cv cath","description":"Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25151","name":"Partial removal of radius","description":"Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); radius","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78800","name":"Rp loclzj tum 1 area 1 d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (eg, head, neck, chest, pelvis), single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55725","name":"Drainage of prostate abscess","description":"Prostatotomy, external drainage of prostatic abscess, any approach; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0111","name":"Crutch forearm each","description":"Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35671","name":"Bpg pop-tibl/-prnl artery","description":"Bypass graft, with other than vein; popliteal-tibial or -peroneal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93631","name":"Ntraop epicar&endcar pac&map","description":"Intra-operative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical correction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":668.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87799","name":"Detect agent nos dna quant","description":"Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; quantification, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B9004","name":"Parenteral infus pump portab","description":"Parenteral nutrition infusion pump, portable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67909","name":"Revise eyelid defect","description":"Reduction of overcorrection of ptosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21743","name":"Repair sternum/nuss w/scope","description":"Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (nuss procedure), with thoracoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":718.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84295","name":"Assay of serum sodium","description":"Sodium; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62120","name":"Repair skull cavity lesion","description":"Repair of encephalocele, skull vault, including cranioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1886.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62252","name":"Csf shunt reprogram","description":"Reprogramming of programmable cerebrospinal shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36822","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50526","name":"Close nephrovisceral fistula","description":"Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1384.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26742","name":"Treat finger fracture each","description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":309.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29879","name":"Arthrs kne srg abrasj arthrp","description":"Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":557.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33688","name":"Clsr 1vsd w/wo ptch rmvl bnd","description":"Closure of single ventricular septal defect, with or without patch; with removal of pulmonary artery band, with or without gusset","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1641.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73200","name":"Ct upper extremity w/o dye","description":"Computed tomography, upper extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75635","name":"Ct angio abdominal arteries","description":"Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42305","name":"Drainage of salivary gland","description":"Drainage of abscess; parotid, complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36870","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1468.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74355","name":"X-ray guide intestinal tube","description":"Percutaneous placement of enteroclysis tube, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54000","name":"Slitting of prepuce","description":"Slitting of prepuce, dorsal or lateral (separate procedure); newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42971","name":"Control nose/throat bleeding","description":"Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); complicated, requiring hospitalization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54326","name":"Reconstruction of urethra","description":"1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps and mobilization of urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":764.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4409","name":"Ost skn barr convex <=4 sq i","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15176","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24620","name":"Cltx monteggia fx dislc elbw","description":"Closed treatment of monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11470","name":"Exc skn h/p/p/u smpl/ntrm","description":"Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44128","name":"Enterectomy cong add-on","description":"Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; each additional resection and anastomosis (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25630","name":"Cltx carpl fx w/o mnpj ea b1","description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51101","name":"Drain bladder by trocar/cath","description":"Aspiration of bladder; by trocar or intracatheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28190","name":"Removal of foot foreign body","description":"Removal of foreign body, foot; subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74445","name":"X-ray exam of penis","description":"Corpora cavernosography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20526","name":"Ther injection carp tunnel","description":"Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93050","name":"Art pressure waveform analys","description":"Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity art","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88185","name":"Flowcytometry/tc add-on","description":"Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (list separately in addition to code for first marker)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82595","name":"Assay of cryoglobulin","description":"Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1686","name":"Ho post-op hip abduction","description":"Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33962","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, 6 years and older (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82985","name":"Assay of glycated protein","description":"Glycated protein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32124","name":"Explore chest free adhesions","description":"Thoracotomy; with open intrapleural pneumonolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93233","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36261","name":"Revision of infusion pump","description":"Revision of implanted intra-arterial infusion pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87118","name":"Mycobacteric identification","description":"Culture, mycobacterial, definitive identification, each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44363","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7028","name":"Repl oral cushion combo mask","description":"Oral cushion for combination oral/nasal mask, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72196","name":"Mri pelvis w/dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3901","name":"Hinge ext/flex wrist finger","description":"Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27692","name":"Revise additional leg tendon","description":"Transfer or transplant of single tendon (with muscle redirection or rerouting); each additional tendon (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11300","name":"Shave skin lesion 0.5 cm/<","description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36572","name":"Insj picc rs&i <5 yr","description":"Insertion of peripherally inserted central venous catheter (picc), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67405","name":"Explore/drain eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32150","name":"Removal of lung lesion(s)","description":"Thoracotomy; with removal of intrapleural foreign body or fibrin deposit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15151","name":"Tis cltr skn agrft t/a/l add","description":"Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46716","name":"Rep perf anoper/vestib fistu","description":"Repair of low imperforate anus; with transposition of anoperineal or anovestibular fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1011.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83518","name":"Immunoassay dipstick","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, single step method (eg, reagent strip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70487","name":"Ct maxillofacial w/dye","description":"Computed tomography, maxillofacial area; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92973","name":"Prq trluml c mchn asp thrmbc","description":"Percutaneous transluminal coronary mechanical aspiration thrombectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77317","name":"Brachytx isodose intermed","description":"Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84270","name":"Assay of sex hormone globul","description":"Sex hormone binding globulin (shbg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27335","name":"Remove knee joint lining","description":"Arthrotomy, with synovectomy, knee; anterior and posterior including popliteal area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82525","name":"Assay of copper","description":"Copper","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53850","name":"Prostatic microwave thermotx","description":"Transurethral destruction of prostate tissue; by microwave thermotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1258.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56620","name":"Vulvectomy simple partial","description":"Vulvectomy simple; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6885","name":"Replc sockt shldr dis/interc","description":"Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1580.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62287","name":"Dcmprn pq nuc pul 1/mlt lmbr","description":"Decompression, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle-based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, sing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1200","name":"Furnsh initial orthosis only","description":"Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":730.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33961","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71275","name":"Ct angiography chest","description":"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1088","name":"Wheelchair lightweight det a","description":"High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43219","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58546","name":"Laparo-myomectomy complex","description":"Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":718.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78428","name":"Cardiac shunt imaging","description":"Cardiac shunt detection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59820","name":"Care of miscarriage","description":"Treatment of missed abortion, completed surgically; first trimester","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":355.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61558","name":"Excision of skull/sutures","description":"Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); not requiring bone grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1716.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84295","name":"Assay of serum sodium","description":"Sodium; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35879","name":"Revise graft w/vein","description":"Revision, lower extremity arterial bypass, without thrombectomy, open; with vein patch angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58559","name":"Hysteroscopy lysis","description":"Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6234","name":"Hydrocolld drg <=16 w/o bdr","description":"Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15003","name":"Wound prep addl 100 cm","description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85247","name":"Clot factor viii multimetric","description":"Clotting; factor viii, von willebrand factor, multimetric analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82980","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54360","name":"Penis plastic surgery","description":"Plastic operation on penis to correct angulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":583.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84035","name":"Assay of phenylketones","description":"Phenylketones, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86609","name":"Bacterium antibody","description":"Antibody; bacterium, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92653","name":"Aep neurodiagnostic i&r","description":"Auditory evoked potentials; neurodiagnostic, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01996","name":"Dly hosp mgmt edrl rx admin","description":"Daily hospital management of epidural or subarachnoid continuous drug administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88291","name":"Cyto/molecular report","description":"Cytogenetics and molecular cytogenetics, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83631","name":"Lactoferrin fecal (quant)","description":"Lactoferrin, fecal; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35650","name":"Bpg axillary-axillary","description":"Bypass graft, with other than vein; axillary-axillary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":901.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50365","name":"Rnl altrnsplj w/rcp nfrct","description":"Renal allotransplantation, implantation of graft; with recipient nephrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2498.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32506","name":"Wedge resect of lung add-on","description":"Thoracotomy; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00810","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2002","name":"Post-d/c h vst new pt 30 m","description":"Limited (30 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35665","name":"Bpg iliofemoral","description":"Bypass graft, with other than vein; iliofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70554","name":"Fmri brain by tech","description":"Magnetic resonance imaging, brain, functional mri; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":341.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49450","name":"Replace g/c tube perc","description":"Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28222","name":"Release of foot tendons","description":"Tenolysis, flexor, foot; multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61615","name":"Resect/excise lesion skull","description":"Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or c1-c3 vertebral bodies; extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2550.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25335","name":"Centralization wrist on ulna","description":"Centralization of wrist on ulna (eg, radial club hand)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":798.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57000","name":"Colpotomy w/exploration","description":"Colpotomy; with exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70140","name":"X-ray exam of facial bones","description":"Radiologic examination, facial bones; less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30118","name":"Removal of intranasal lesion","description":"Excision or destruction (eg, laser), intranasal lesion; external approach (lateral rhinotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44155","name":"Removal of colon/ileostomy","description":"Colectomy, total, abdominal, with proctectomy; with ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1682.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50200","name":"Renal biopsy perq","description":"Renal biopsy; percutaneous, by trocar or needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2215","name":"Pneumatic caster tire tube","description":"Manual wheelchair accessory, tube for pneumatic caster tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7004","name":"Disposable nebulizer sml vol","description":"Small volume nonfiltered pneumatic nebulizer, disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48545","name":"Pancreatorrhaphy","description":"Pancreatorrhaphy for injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36569","name":"Insj picc 5 yr+ w/o imaging","description":"Insertion of peripherally inserted central venous catheter (picc), without subcutaneous port or pump, without imaging guidance; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71552","name":"Mri chest w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3923","name":"Hfo without joints pre cst","description":"Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4434","name":"Ost pch urine w lock flng/ft","description":"Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2012","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33981","name":"Replace vad pump ext","description":"Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24126","name":"Exc/crtg b1 cst/tum rds algr","description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95908","name":"Nrv cndj tst 3-4 studies","description":"Nerve conduction studies; 3-4 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92618","name":"Ex for nonspeech dev rx add","description":"Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00702","name":"Anes upr ant abd wall lvr bx","description":"Anesthesia for procedures on upper anterior abdominal wall; percutaneous liver biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6533","name":"Gc stocking thighlngth 18-30","description":"Gradient compression stocking, thigh length, 18-30 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4480","name":"Vabra aspirator","description":"Vabra aspirator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28119","name":"Removal of heel spur","description":"Ostectomy, calcaneus; for spur, with or without plantar fascial release","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":423.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0776","name":"Iv pole","description":"Iv pole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","BA","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75805","name":"Lymph vessel x-ray trunk","description":"Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63706","name":"Repair of spinal herniation","description":"Repair of myelomeningocele; larger than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59135","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":828.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4222","name":"Parenteral supply kit homemi","description":"Parenteral nutrition supply kit; home mix, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0116","name":"Crutch underarm each no wood","description":"Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33275","name":"Tcat rmvl perm ldls pm w/img","description":"Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87158","name":"Culture typing added method","description":"Culture, typing; other methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65900","name":"Remove eye lesion","description":"Removal of epithelial downgrowth, anterior chamber of eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":589.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11470","name":"Exc skn h/p/p/u smpl/ntrm","description":"Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53854","name":"Trurl dstrj prst8 tiss rf wv","description":"Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42500","name":"Repair salivary duct","description":"Plastic repair of salivary duct, sialodochoplasty; primary or simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93278","name":"Ecg/signal-averaged","description":"Signal-averaged electrocardiography (saecg), with or without ecg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15783","name":"Dermabrasion suprfl any site","description":"Dermabrasion; superficial, any site (eg, tattoo removal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":284.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55450","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27592","name":"Amputate leg at thigh","description":"Amputation, thigh, through femur, any level; open, circular (guillotine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":584.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27647","name":"Resect talus/calcaneus tum","description":"Radical resection of tumor; talus or calcaneus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":798.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92134","name":"Cptrz oph dx img pst sgm rta","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), posterior segment, with interpretation and report, unilateral or bilateral; retina","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70320","name":"Full mouth x-ray of teeth","description":"Radiologic examination, teeth; complete, full mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1830","name":"Ko immob canvas long pre ots","description":"Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42815","name":"Excision of neck cyst","description":"Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37160","name":"Revision of circulation","description":"Venous anastomosis, open; caval-mesenteric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1947.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73090","name":"X-ray exam of forearm","description":"Radiologic examination; forearm, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75741","name":"Artery x-rays lung","description":"Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78630","name":"Cerebrospinal fluid scan","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":274.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66500","name":"Incision of iris","description":"Iridotomy by stab incision (separate procedure); except transfixion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0180","name":"Md certification hha patient","description":"Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22868","name":"Insj stablj dev w/dcmprn","description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88372","name":"Protein analysis w/probe","description":"Protein analysis of tissue by western blot, with interpretation and report; immunological probe for band identification, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01716","name":"Anes nrv msc upr a&e tndsis","description":"Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenodesis, rupture of long tendon of biceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68420","name":"I&d lacrimal sac","description":"Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93654","name":"Compre ep eval tx vt","description":"Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensiona","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7501","name":"Tracheostoma valve w diaphra","description":"Tracheostoma valve, including diaphragm, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72196","name":"Mri pelvis w/dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28008","name":"Incision of foot fascia","description":"Fasciotomy, foot and/or toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":349.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70551","name":"Mri brain stem w/o dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49429","name":"Removal of shunt","description":"Removal of peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33771","name":"Rpr tga w/surg enlgmnt vsd","description":"Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; with surgical enlargement of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70548","name":"Mr angiography neck w/dye","description":"Magnetic resonance angiography, neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76941","name":"Echo guide for transfusion","description":"Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86480","name":"Tb test cell immun measure","description":"Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2106","name":"Afo tib fx cast plaster mold","description":"Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":406.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2010","name":"Kafo sng solid stirrup w/o j","description":"Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar ak orthosis), without knee joint, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11444","name":"Exc face-mm b9+marg 3.1-4 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30901","name":"Control of nosebleed","description":"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35102","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels (common, hypogastric, external)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1657.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2387","name":"Add le poly knee custom kafo","description":"Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2311","name":"Lens sphc trifo 7.25-12/.25-","description":"Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15400","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":292.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37232","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":513.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7040","name":"One way chest drain valve","description":"One way chest drain valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95812","name":"Eeg 41-60 minutes","description":"Electroencephalogram (eeg) extended monitoring; 41-60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27814","name":"Treatment of ankle fracture","description":"Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87102","name":"Fungus isolation culture","description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8002","name":"Brst prsth bra & bilat form","description":"Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4321","name":"Cath therapeutic irrig agent","description":"Therapeutic agent for urinary catheter irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22558","name":"Arthrd ant ntrbd min dsc lum","description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1339.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32110","name":"Explore/repair chest","description":"Thoracotomy; with control of traumatic hemorrhage and/or repair of lung tear","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1169.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23130","name":"Acromp/acromionectomy prtl","description":"Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":515.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95950","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5785","name":"Exoskeletal bk ultralt mater","description":"Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93464","name":"Exercise w/hemodynamic meas","description":"Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43254","name":"Egd endo mucosal resection","description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31635","name":"Bronchoscopy w/fb removal","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8045","name":"Auricular prosthesis","description":"Auricular prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1429.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82271","name":"Occult blood other sources","description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26170","name":"Removal of palm tendon each","description":"Excision of tendon, palm, flexor or extensor, single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3762","name":"Eo rigid w/o joints pre ots","description":"Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5712","name":"Knee-shin exo frict swg & st","description":"Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42340","name":"Removal of salivary stone","description":"Sialolithotomy; parotid, extraoral or complicated intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92227","name":"Img rta detcj/mntr ds staff","description":"Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88161","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; preparation, screening and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33766","name":"Shunt supr v/c p-art 1 lung","description":"Shunt; superior vena cava to pulmonary artery for flow to 1 lung (classical glenn procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50700","name":"Revision of ureter","description":"Ureteroplasty, plastic operation on ureter (eg, stricture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":748.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99315","name":"Nf dschrg mgmt 30 min/less","description":"Nursing facility discharge management; 30 minutes or less total time on the date of the encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28540","name":"Treat foot dislocation","description":"Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84078","name":"Assay alkaline phosphatase","description":"Phosphatase, alkaline; heat stable (total not included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69661","name":"Revise middle ear bone","description":"Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; with footplate drill out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":974.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29867","name":"Allgrft implnt knee w/scope","description":"Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1081.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20983","name":"Ablate bone tumor(s) perq","description":"Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5649","name":"Isch containmt/narrow m-l so","description":"Addition to lower extremity, ischial containment/narrow m-l socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":945.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44385","name":"Endoscopy of bowel pouch","description":"Endoscopic evaluation of small intestinal pouch (eg, kock pouch, ileal reservoir [s or j]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36568","name":"Insj picc <5 yr w/o imaging","description":"Insertion of peripherally inserted central venous catheter (picc), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87305","name":"Aspergillus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; aspergillus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28113","name":"Part removal of metatarsal","description":"Ostectomy, complete excision; fifth metatarsal head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53220","name":"Treatment of urethra lesion","description":"Excision or fulguration of carcinoma of urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":365.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43194","name":"Esophagoscp rig trnso rem fb","description":"Esophagoscopy, rigid, transoral; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94660","name":"Cpap initiation&mgmt","description":"Continuous positive airway pressure ventilation (cpap), initiation and management","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2510","name":"Sgd w multi methods msg/accs","description":"Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15110","name":"Epidrm agrft t/a/l 1st 100","description":"Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":515.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61645","name":"Perq art m-thrombect &/nfs","description":"Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22514","name":"Perq vertebral augmentation","description":"Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5370.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93308","name":"Tte f-up or lmtd","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6930","name":"Below elbow switch control","description":"Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0601","name":"Cont airway pressure device","description":"Continuous positive airway pressure (cpap) device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3031","name":"Foot lamin/prepreg composite","description":"Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1820","name":"Ko elas w/ condyle pads & jo","description":"Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4100","name":"Food thickener oral","description":"Food thickener, administered orally, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82489","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0009","name":"Admin pneumococcal vaccine","description":"Administration of pneumococcal vaccine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0959","name":"Amputee adapter","description":"Manual wheelchair accessory, adapter for amputee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90815","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55180","name":"Revision of scrotum","description":"Scrotoplasty; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25922","name":"Amputate hand at wrist","description":"Disarticulation through wrist; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":528.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5828","name":"Endo knee-shin fluid swg/sta","description":"Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22512","name":"Vertebroplasty addl inject","description":"Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":695.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70544","name":"Mr angiography head w/o dye","description":"Magnetic resonance angiography, head; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99242","name":"Off/op consltj new/est sf 20","description":"Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74221","name":"X-ray xm esophagus 2cntrst","description":"Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0023","name":"Pin service 60m per month","description":"Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities:  person-centered assessment, performed to better understand the indiv","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21081","name":"Impres&prep mndbl res prosth","description":"Impression and custom preparation; mandibular resection prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1269.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76936","name":"Echo guide for artery repair","description":"Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01230","name":"Anes opn upper 2/3 femur nos","description":"Anesthesia for open procedures involving upper two-thirds of femur; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43653","name":"Laparoscopy gastrostomy","description":"Laparoscopy, surgical; gastrostomy, without construction of gastric tube (eg, stamm procedure) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":476.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4393","name":"Urine pch w ex wear bar conv","description":"Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4221","name":"Supp non-insulin inf cath/wk","description":"Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs  separately)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87622","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23220","name":"Radical rescj tumor prox hum","description":"Radical resection of tumor, proximal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6447","name":"Conform band s w >=5in/yd","description":"Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33776","name":"Rpr tga atr bfl clsr vsd","description":"Repair of transposition of the great arteries, atrial baffle procedure (eg, mustard or senning type) with cardiopulmonary bypass; with closure of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50391","name":"Instll rx agnt into rnal tub","description":"Instillation(s) of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83915","name":"Assay of nucleotidase","description":"Nucleotidase 5-","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87500","name":"Vanomycin dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); vancomycin resistance (eg, enterococcus species van a, van b), amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7510","name":"Prosthetic device repair rep","description":"Repair of prosthetic device, repair or replace minor parts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84220","name":"Assay of pyruvate kinase","description":"Pyruvate kinase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93284","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous impla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70210","name":"X-ray exam of sinuses","description":"Radiologic examination, sinuses, paranasal, less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99218","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20705","name":"Rmvl i-artic rx delivery dev","description":"Removal of drug-delivery device(s), intra-articular (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74283","name":"Ther nma rdctj intus/obstrcj","description":"Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium ileus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20912","name":"Remove cartilage for graft","description":"Cartilage graft; nasal septum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47570","name":"Laparo cholecystoenterostomy","description":"Laparoscopy, surgical; cholecystoenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":649.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92597","name":"Oral speech device eval","description":"Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68811","name":"Probe nasolacrimal duct","description":"Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27420","name":"Revision of unstable kneecap","description":"Reconstruction of dislocating patella; (eg, hauser type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":626.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29530","name":"Strapping of knee","description":"Strapping; knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0859","name":"Pwc gp3 hd sing pow opt cap","description":"Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0143","name":"Scr c/v cyto,thinlayer,rescr","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27594","name":"Amputation follow-up surgery","description":"Amputation, thigh, through femur, any level; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52315","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":374.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1002","name":"Pwr seat tilt","description":"Wheelchair accessory, power seating system, tilt only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88160","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; screening and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78459","name":"Myocrd img pet single study","description":"Myocardial imaging, positron emission tomography (pet), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1060.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13151","name":"Cmplx rpr e/n/e/l 1.1-2.5 cm","description":"Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5055","name":"Stoma cap","description":"Stoma cap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3671","name":"So cap design w/o jnts cf","description":"Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81099","name":"Unlisted urinalysis px","description":"Unlisted urinalysis procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27552","name":"Treat knee dislocation","description":"Closed treatment of knee dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31300","name":"Removal of larynx lesion","description":"Laryngotomy (thyrotomy, laryngofissure), with removal of tumor or laryngocele, cordectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":948.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50576","name":"Kidney endoscopy & treatment","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36516","name":"Apheresis immunoads slctv","description":"Therapeutic apheresis; with extracorporeal immunoadsorption, selective adsorption or selective filtration and plasma reinfusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1007","name":"Pwr seat combo w/shear","description":"Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33542","name":"Removal of heart lesion","description":"Myocardial resection (eg, ventricular aneurysmectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2288.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88143","name":"Cytopath c/v thin layer redo","description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5631","name":"Ak/knee disartic acrylic soc","description":"Addition to lower extremity, above knee or knee disarticulation, acrylic socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3960","name":"Sewho airplan desig abdu pos","description":"Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":343.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77013","name":"Ct guide for tissue ablation","description":"Computed tomography guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52265","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6549","name":"Grad com garm noc day use","description":"Gradient compression garment, not otherwise specified, for daytime use, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40818","name":"Excise oral mucosa for graft","description":"Excision of mucosa of vestibule of mouth as donor graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0562T","name":"Antmc guide 3d print ea addl","description":"Anatomic guide 3d-printed and designed from image data set(s); each additional anatomic guide (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32810","name":"Close chest after drainage","description":"Closure of chest wall following open flap drainage for empyema (clagett type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":717.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72170","name":"X-ray exam of pelvis","description":"Radiologic examination, pelvis; 1 or 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00120","name":"Anes px ear w/bx nos","description":"Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49081","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0098","name":"Drive belt for pwc, repl","description":"Drive belt for power wheelchair, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00813","name":"Anes upr lwr gi ndsc px","description":"Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93455","name":"Coronary art/grft angio s&i","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injecti","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1043.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22900","name":"Exc abdl tum deep < 5 cm","description":"Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6930","name":"Below elbow switch control","description":"Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3331.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88368","name":"Insitu hybridization manual","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86891","name":"Autologous blood op salvage","description":"Autologous blood or component, collection processing and storage; intra- or postoperative salvage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73020","name":"X-ray exam of shoulder","description":"Radiologic examination, shoulder; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95911","name":"Nrv cndj test 9-10 studies","description":"Nerve conduction studies; 9-10 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77615","name":"Hyperthermia ntrstl prb>5","description":"Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82975","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84143","name":"Assay of 17-hydroxypregneno","description":"17-hydroxypregnenolone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64907","name":"Nerve pedicle transfer","description":"Nerve pedicle transfer; second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0107T","name":"Vibrate quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using vibration stimuli to assess large diameter fiber sensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61540","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, without electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1998.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99446","name":"Ntrprof ph1/ntrnet/ehr 5-10","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patients treating/requesting physician or other qualified health care profess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33980","name":"Remove intracorporeal device","description":"Removal of ventricular assist device, implantable intracorporeal, single ventricle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1549.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00844","name":"Anes iper px abdmnprnl rescj","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; abdominoperineal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63046","name":"Lam facetec & foramot thrc","description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1091.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35331","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; abdominal aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1279.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64718","name":"Revise ulnar nerve at elbow","description":"Neuroplasty and/or transposition; ulnar nerve at elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2620","name":"Pelvic control hip heavy dut","description":"Addition to lower extremity, pelvic control, hip joint, heavy duty, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8501","name":"Tracheostomy speaking valve","description":"Tracheostomy speaking valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92284","name":"Dx dark adaptation exam i&r","description":"Diagnostic dark adaptation examination (eg, rod and cone sensitivities, rod-cone breakpoint), with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A8003","name":"Hard protect helmet custom","description":"Helmet, protective, hard, custom fabricated, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35301","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":996.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2608","name":"Skin pro/pos wc cus wd>=22in","description":"Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27091","name":"Removal of hip prosthesis","description":"Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1354.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26121","name":"Release palm contracture","description":"Fasciectomy, palm only, with or without z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62201","name":"Brain cavity shunt w/scope","description":"Ventriculocisternostomy, third ventricle; stereotactic, neuroendoscopic method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49451","name":"Replace duod/jej tube perc","description":"Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":550.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7362","name":"Battery chrgr six volt otto","description":"Battery charger, six volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43855","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1420.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65155","name":"Reinsert ocular implant","description":"Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64774","name":"Remove skin nerve lesion","description":"Excision of neuroma; cutaneous nerve, surgically identifiable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78610","name":"Brain flow imaging only","description":"Brain imaging, vascular flow only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0628","name":"Lso flex no ri stays pre ots","description":"Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefab","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45385","name":"Colonoscopy w/lesion removal","description":"Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11463","name":"Exc skn hdrdnt ing complex","description":"Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28001","name":"Drainage of bursa of foot","description":"Incision and drainage, bursa, foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17274","name":"Dstr mal les s/n/h/f/g 3.1-4","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27892","name":"Decompression of leg","description":"Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":465.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61886","name":"Implant neurostim arrays","description":"Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":766.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6647","name":"Shoulder lock actuator","description":"Upper extremity addition, shoulder lock mechanism, body powered actuator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27508","name":"Treatment of thigh fracture","description":"Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94016","name":"Review patient spirometry","description":"Patient-initiated spirometric recording per 30-day period of time; review and interpretation only by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4083","name":"Enteral stomach tube levine","description":"Stomach tube - levine type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96366","name":"Ther/proph/diag iv inf addon","description":"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94150","name":"Vital capacity test","description":"Vital capacity, total (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45905","name":"Dilation of anal sphincter","description":"Dilation of anal sphincter (separate procedure) under anesthesia other than local","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4380","name":"Urinary rubber pouch w fcplt","description":"Ostomy pouch, urinary, with faceplate attached, rubber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15760","name":"Composite skin graft","description":"Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":526.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95912","name":"Nrv cndj test 11-12 studies","description":"Nerve conduction studies; 11-12 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0950","name":"Tray","description":"Wheelchair accessory, tray, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72128","name":"Ct chest spine w/o dye","description":"Computed tomography, thoracic spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9869","name":"Cmmi asyntelehealth 10-20min","description":"Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5692","name":"Ak pelvic control belt light","description":"Addition to lower extremity, above knee, pelvic control belt, light","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1296","name":"Wheelchair special seat heig","description":"Special wheelchair seat height from floor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51785","name":"Anal/urinary muscle study","description":"Needle electromyography studies (emg) of anal or urethral sphincter, any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":309.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61450","name":"Crnec stpl sctj cmprn/dcmprn","description":"Craniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26746","name":"Treat finger fracture each","description":"Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17111","name":"Destruction b9 lesions 15/>","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35182","name":"Rpr cgen av fistula thrx&abd","description":"Repair, congenital arteriovenous fistula; thorax and abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1554.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93012","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":164.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23420","name":"Repair of shoulder","description":"Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92134","name":"Cptrz oph dx img pst sgm rta","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), posterior segment, with interpretation and report, unilateral or bilateral; retina","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4398","name":"Ostomy irrigation bag","description":"Ostomy irrigation supply; bag, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99415","name":"Prolng clin staff svc 1st hr","description":"Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (list separately in addition to code for out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63040","name":"Laminotomy single cervical","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1235.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97545","name":"Work hardening","description":"Work hardening/conditioning; initial 2 hours","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4660","name":"Sphyg/bp app w cuff and stet","description":"Sphygmomanometer/blood pressure apparatus with cuff and stethoscope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35820","name":"Explore chest vessels","description":"Exploration for postoperative hemorrhage, thrombosis or infection; chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3080","name":"Arch supp att to shoe metata","description":"Foot, arch support, non-removable attached to shoe, metatarsal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41805","name":"Removal foreign body gum","description":"Removal of embedded foreign body from dentoalveolar structures; soft tissues","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":227.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93542","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93798","name":"Phys/qhp op car rhab w/ecg","description":"Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ecg monitoring (per session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28302","name":"Incision of ankle bone","description":"Osteotomy; talus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":604.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0081","name":"Care man h v ext pt 20 mi","description":"Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64704","name":"Revise hand/foot nerve","description":"Neuroplasty; nerve of hand or foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77056","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82747","name":"Assay of folic acid rbc","description":"Folic acid; rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43108","name":"Removal of esophagus","description":"Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83921","name":"Organic acid single quant","description":"Organic acid, single, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0140","name":"Walker w trunk support","description":"Walker, with trunk support, adjustable or fixed height, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80438","name":"Trh stimulation panel","description":"Thyrotropin releasing hormone (trh) stimulation panel; 1 hour this panel must include the following: thyroid stimulating hormone (tsh) (84443 x 3)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64590","name":"Ins/rpl prph sac/gstr npg/r","description":"Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5972","name":"Flexible keel foot","description":"All lower extremity prostheses, foot, flexible keel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92518","name":"Vemp test i&r ocular","description":"Vestibular evoked myogenic potential (vemp) testing, with interpretation and report; ocular (ovemp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78598","name":"Lung perf&ventilat diferentl","description":"Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2219","name":"Lens bifocal seg width over","description":"Bifocal seg width over 28 mm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6384","name":"Postop dsg cast chg shlder/t","description":"Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27722","name":"Repair/graft of tibia","description":"Repair of nonunion or malunion, tibia; with sliding graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61316","name":"Inc&subq plmt crnl bone grf","description":"Incision and subcutaneous placement of cranial bone graft (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23066","name":"Biopsy shoulder tissues","description":"Biopsy, soft tissue of shoulder area; deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":470.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23180","name":"Prtl excision bone clavicle","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":563.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95872","name":"Ndl emg single fiber eltrd","description":"Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82139","name":"Amino acids quan 6 or more","description":"Amino acids, 6 or more amino acids, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24586","name":"Optx partclr fx&/dislc elbow","description":"Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":917.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52300","name":"Cystoscopy and treatment","description":"Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61316","name":"Inc&subq plmt crnl bone grf","description":"Incision and subcutaneous placement of cranial bone graft (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37616","name":"Ligation major artery chest","description":"Ligation, major artery (eg, post-traumatic, rupture); chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":957.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31240","name":"Nsl/sns ndsc cnch bull rescj","description":"Nasal/sinus endoscopy, surgical; with concha bullosa resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81518","name":"Onc brst mrna 11 genes","description":"Oncology (breast), mrna, gene expression profiling by real-time rt-pcr of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1936.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47562","name":"Laparoscopic cholecystectomy","description":"Laparoscopy, surgical; cholecystectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0456","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99473","name":"Self-meas bp pt educaj/train","description":"Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2111","name":"Spherocylindr 7.25d/.25-2.25","description":"Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0007","name":"Extra heavy duty wheelchair","description":"Extra heavy duty wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43327","name":"Esoph fundoplasty lap","description":"Esophagogastric fundoplasty partial or complete; laparotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64872","name":"Subsequent repair of nerve","description":"Suture of nerve; requiring secondary or delayed suture (list separately in addition to code for primary neurorrhaphy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81311","name":"Nras gene variants exon 2&3","description":"Nras (neuroblastoma ras viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64911","name":"Neurorraphy w/vein autograft","description":"Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16030","name":"Dress/debrid p-thick burn l","description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than 1 extremity, or greater than 10% total body surface area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2680","name":"Thorac cont lat support upri","description":"Addition to lower extremity, thoracic control, lateral support uprights","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4353","name":"Intermittent urinary cath","description":"Intermittent urinary catheter, with insertion supplies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66505","name":"Incision of iris","description":"Iridotomy by stab incision (separate procedure); with transfixion as for iris bombe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77333","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28485","name":"Optx metatarsal fx each","description":"Open treatment of metatarsal fracture, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":448.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67039","name":"Laser treatment of retina","description":"Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33340","name":"Perq clsr tcat l atr apndge","description":"Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0232T","name":"Njx platelet plasma","description":"Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0129","name":"Php/iop ot service","description":"Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4559","name":"Coupling gel or paste","description":"Coupling gel or paste, for use with ultrasound device, per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24505","name":"Cltx humrl shft fx w/mnpj","description":"Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":416.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44188","name":"Lap colostomy","description":"Laparoscopy, surgical, colostomy or skin level cecostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":998.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95938","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":237.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92575","name":"Sensorineural acuity lvl tst","description":"Sensorineural acuity level test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69711","name":"Remove/repair hearing aid","description":"Removal or repair of electromagnetic bone conduction hearing device in temporal bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":682.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26118","name":"Rad resect hand tumor 3 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":885.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82671","name":"Assay of estrogens","description":"Estrogens; fractionated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71010","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4524","name":"Adult size brief/diaper xl","description":"Adult sized disposable incontinence product, brief/diaper, extra large, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82977","name":"Assay of ggt","description":"Glutamyltransferase, gamma (ggt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39402","name":"Mediastinoscpy w/lmph nod bx","description":"Mediastinoscopy; with lymph node biopsy(ies) (eg, lung cancer staging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74018","name":"Radex abdomen 1 view","description":"Radiologic examination, abdomen; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21261","name":"Revise eye sockets","description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2059.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21077","name":"Impres&prep orbital prosth","description":"Impression and custom preparation; orbital prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1770.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0079","name":"Care manag h vst new pt 60 m","description":"Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6210","name":"Foam drg >16<=48 sq in w/o b","description":"Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0478","name":"Power adapter, combo vad","description":"Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24530","name":"Cltx sprcndylr humeral fx wo","description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22632","name":"Arthrd pst tq 1ntrspc lm ea","description":"Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86793","name":"Yersinia antibody","description":"Antibody; yersinia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27268","name":"Cltx thigh fx w/mnpj","description":"Closed treatment of femoral fracture, proximal end, head; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30140","name":"Resect inferior turbinate","description":"Submucous resection inferior turbinate, partial or complete, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2375","name":"Torsion ank & half solid sti","description":"Addition to lower extremity, torsion control, ankle joint and half solid stirrup","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6451","name":"Mod compres band w>=3in<5in/yd","description":"Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63197","name":"Lam w/cordotomy 1stg thrc","description":"Laminectomy with cordotomy, with section of both spinothalamic tracts, 1 stage, thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1562.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92549","name":"Cdp-sot 6 cond w/i&r mct&adt","description":"Computerized dynamic posturography sensory organization test (cdp-sot), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (mct) and adaptation test (adt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92611","name":"Motion fluoroscopy/swallow","description":"Motion fluoroscopic evaluation of swallowing function by cine or video recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31570","name":"Laryngoscope w/vc inj","description":"Laryngoscopy, direct, with injection into vocal cord(s), therapeutic;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36479","name":"Endovenous laser vein addon","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11921","name":"Correct skn color 6.1-20.0cm","description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78468","name":"Heart infarct image (ef)","description":"Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89320","name":"Semen anal vol/count/mot","description":"Semen analysis; volume, count, motility, and differential","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3929","name":"Hfo nontorsion jnts pre cst","description":"Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64454","name":"Njx aa&/strd gnclr nrv brnch","description":"Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4220","name":"Infusion pump refill kit","description":"Refill kit for implantable infusion pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2660","name":"Thoracic control thoracic ba","description":"Addition to lower extremity, thoracic control, thoracic band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99477","name":"Init day hosp neonate care","description":"Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34800","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":958.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28126","name":"Partial removal of toe","description":"Resection, partial or complete, phalangeal base, each toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51530","name":"Removal of bladder lesion","description":"Cystotomy; for excision of bladder tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33778","name":"Rpr tga aortic pulm art rcns","description":"Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, jatene type);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94720","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56420","name":"I&d bartholins gland abscess","description":"Incision and drainage of bartholins gland abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87271","name":"Cytomegalovirus dfa","description":"Infectious agent antigen detection by immunofluorescent technique; cytomegalovirus, direct fluorescent antibody (dfa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85044","name":"Manual reticulocyte count","description":"Blood count; reticulocyte, manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75984","name":"Xray control catheter change","description":"Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78013","name":"Thyroid imaging w/blood flow","description":"Thyroid imaging (including vascular flow, when performed);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4397","name":"Static or dynami afo pre ots","description":"Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73090","name":"X-ray exam of forearm","description":"Radiologic examination; forearm, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0448T","name":"Remvl insj impltbl gluc sens","description":"Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27409","name":"Repair of knee ligaments","description":"Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1003","name":"Pwr seat recline","description":"Wheelchair accessory, power seating system, recline only, without shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21268","name":"Revise eye sockets","description":"Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; combined intra- and extracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85555","name":"Rbc osmotic fragility","description":"Osmotic fragility, rbc; unincubated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0561T","name":"Antmc guide 3d print 1st gd","description":"Anatomic guide 3d-printed and designed from image data set(s); first anatomic guide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35884","name":"Revj fem anast autog vn grf","description":"Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with autogenous vein patch graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP07","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01212","name":"Anes open px hip jt disrtcj","description":"Anesthesia for open procedures involving hip joint; hip disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11603","name":"Exc tr-ext mal+marg 2.1-3 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4344","name":"Cath indw foley 2 way silicn","description":"Indwelling catheter, foley type, two-way, all silicone or polyurethane, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53410","name":"Reconstruction of urethra","description":"Urethroplasty, 1-stage reconstruction of male anterior urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":791.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00352","name":"Anes px maj vsl nck smpl lig","description":"Anesthesia for procedures on major vessels of neck; simple ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0544T","name":"Tcat mv annulus rcnstj","description":"Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1093.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88160","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; screening and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61651","name":"Evasc prlng admn rx agnt add","description":"Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each additional vascular territory (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0019","name":"Arm pad repl, each","description":"Arm pad, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92283","name":"Extnd color vision xm","description":"Color vision examination, extended, eg, anomaloscope or equivalent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84443","name":"Assay thyroid stim hormone","description":"Thyroid stimulating hormone (tsh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46746","name":"Repair of cloacal anomaly","description":"Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21196","name":"Reconst lwr jaw w/fixation","description":"Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1038","name":"Transport chair pt wt<=300lb","description":"Transport chair, adult size, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76706","name":"Us abdl aorta screen aaa","description":"Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (aaa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0404","name":"Ekg tracing for initial prev","description":"Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23462","name":"Repair shoulder capsule","description":"Capsulorrhaphy, anterior, any type; with coracoid process transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36100","name":"Establish access to artery","description":"Introduction of needle or intracatheter, carotid or vertebral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77600","name":"Hyperthermia ext gen supfc","description":"Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92640","name":"Aud brainstem implt programg","description":"Diagnostic analysis with programming of auditory brainstem implant, per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87426","name":"Sarscov coronavirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, sars-cov, s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62280","name":"Treat spinal cord lesion","description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44604","name":"Suture large intestine","description":"Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34704","name":"Evasc rpr a-unilac ndgft rpt","description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2008.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67101","name":"Repair detached retina crtx","description":"Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28495","name":"Treat big toe fracture","description":"Closed treatment of fracture great toe, phalanx or phalanges; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92012","name":"Intrm oph exam est patient","description":"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27832","name":"Treat lower leg dislocation","description":"Open treatment of proximal tibiofibular joint dislocation, includes internal fixation, when performed, or with excision of proximal fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43771","name":"Lap revise gastr adj device","description":"Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6016","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":223.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21079","name":"Impres&prep intrm obt prosth","description":"Impression and custom preparation; interim obturator prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1206.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35494","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":588.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33762","name":"Shunt desc aorta to pulm art","description":"Shunt; descending aorta to pulmonary artery (potts-smith type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67971","name":"Reconstruction of eyelid","description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":434.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75774","name":"Artery x-ray each vessel","description":"Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35501","name":"Art byp grft ipsilat carotid","description":"Bypass graft, with vein; common carotid-ipsilateral internal carotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9512","name":"Tc99m pertechnetate","description":"Technetium tc-99m pertechnetate, diagnostic, per millicurie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41150","name":"Tongue mouth jaw surgery","description":"Glossectomy; composite procedure with resection floor of mouth and mandibular resection, without radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0565","name":"Compressor air power source","description":"Compressor, air power source for equipment which is not self-contained or cylinder driven","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72157","name":"Mri chest spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36585","name":"Replace picvad cath","description":"Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2531","name":"Contact lens gas permeable","description":"Contact lens, scleral, gas permeable, per lens (for contact lens modification, see 92325)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":269.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0624","name":"Sio panel custom","description":"Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27220","name":"Treat hip socket fracture","description":"Closed treatment of acetabulum (hip socket) fracture(s); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":361.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64905","name":"Nerve pedicle transfer","description":"Nerve pedicle transfer; first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":861.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93317","name":"Echo transesophageal","description":"Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32550","name":"Insert pleural cath","description":"Insertion of indwelling tunneled pleural catheter with cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0637","name":"Lso sc r ant/pos pnl pre cst","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64831","name":"Repair of digit nerve","description":"Suture of digital nerve, hand or foot; 1 nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":575.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93293","name":"Pm phone r-strip device eval","description":"Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6450","name":"Elb disart prosth tiss shap","description":"Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1539.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84075","name":"Assay alkaline phosphatase","description":"Phosphatase, alkaline;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88331","name":"Path consltj surg 1 blk 1spc","description":"Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28173","name":"Resect metatarsal tumor","description":"Radical resection of tumor; metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":579.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0836","name":"Pwc gp2 std sing pow opt cap","description":"Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34710","name":"Dlyd plmt xtn prosth 1st vsl","description":"Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74360","name":"X-ray guide gi dilation","description":"Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2209","name":"Lens sphcy bifocal 4.25-7/4.","description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01810","name":"Anes px nrv musc f/arm wrst","description":"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97607","name":"Neg prs wnd thr ndme<=50sqcm","description":"Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surfac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82374","name":"Assay blood carbon dioxide","description":"Carbon dioxide (bicarbonate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5857","name":"Elec knee-shin swing only","description":"Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00212","name":"Anes icr px subdural taps","description":"Anesthesia for intracranial procedures; subdural taps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76510","name":"Oph us dx b-scan&quan a-scan","description":"Ophthalmic ultrasound, diagnostic; b-scan and quantitative a-scan performed during the same patient encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94375","name":"Respiratory flow volume loop","description":"Respiratory flow volume loop","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36260","name":"Insertion of infusion pump","description":"Insertion of implantable intra-arterial infusion pump (eg, for chemotherapy of liver)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67005","name":"Partial removal of eye fluid","description":"Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26500","name":"Hand tendon reconstruction","description":"Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":526.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47141","name":"Partial removal donor liver","description":"Donor hepatectomy (including cold preservation), from living donor; total left lobectomy (segments ii, iii and iv)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8681","name":"Pt prgrm for implt neurostim","description":"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":714.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31087","name":"Removal of frontal sinus","description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, coronal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":820.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4370","name":"Pneum full leg splnt pre ots","description":"Pneumatic full leg splint, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19126","name":"Excision addl breast lesion","description":"Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46940","name":"Treatment of anal fissure","description":"Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0202U","name":"Nfct ds 22 trgt sars-cov-2","description":"Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (dna or rna), 22 targets including severe acute respiratory syndrome coronavirus 2 (sars-cov-2), qualitative rt-pcr, nasopharyngeal swab, each pathogen reported as detected or not detected","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15958","name":"Exc trchntr pr ulc prep ostc","description":"Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23472","name":"Reconstruct shoulder joint","description":"Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder))","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19083","name":"Bx breast 1st lesion us imag","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":373.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0140","name":"Cervical semi-rigid adjustab","description":"Cervical, semi-rigid, adjustable (plastic collar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33016","name":"Pericardiocentesis w/imaging","description":"Pericardiocentesis, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31040","name":"Exploration behind upper jaw","description":"Pterygomaxillary fossa surgery, any approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57400","name":"Dilation of vagina","description":"Dilation of vagina under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78808","name":"Iv inj ra drug dx study","description":"Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid adenoma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00830","name":"Anes hernia rpr lwr abd nos","description":"Anesthesia for hernia repairs in lower abdomen; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01829","name":"Anes dx arthroscopic px wrst","description":"Anesthesia for diagnostic arthroscopic procedures on the wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64787","name":"Implant nerve end","description":"Implantation of nerve end into bone or muscle (list separately in addition to neuroma excision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2311","name":"Electro connect btw 2 sys","description":"Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00454","name":"Anes px clav&scapula bx clav","description":"Anesthesia for procedures on clavicle and scapula; biopsy of clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65770","name":"Keratoprosthesis","description":"Keratoprosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27703","name":"Reconstruction ankle joint","description":"Arthroplasty, ankle; revision, total ankle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61850","name":"Implant neuroelectrodes","description":"Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84155","name":"Assay of protein serum","description":"Protein, total, except by refractometry; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61680","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; supratentorial, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2062.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31551","name":"Laryngoplasty laryngeal sten","description":"Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1143.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5000","name":"Sho insert w arch toe filler","description":"Partial foot, shoe insert with longitudinal arch, toe filler","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58970","name":"Retrieval of oocyte","description":"Follicle puncture for oocyte retrieval, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31592","name":"Cricotracheal resection","description":"Cricotracheal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49565","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2850","name":"Femoral lgth sock fx or equa","description":"Addition to lower extremity orthosis, femoral length sock, fracture or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86713","name":"Legionella antibody","description":"Antibody; legionella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82775","name":"Assay galactose transferase","description":"Galactose-1-phosphate uridyl transferase; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30320","name":"Remove nasal foreign body","description":"Removal foreign body, intranasal; by lateral rhinotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32551","name":"Insertion of chest tube","description":"Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57307","name":"Fistula repair & colostomy","description":"Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25350","name":"Revision of radius","description":"Osteotomy, radius; distal third","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67810","name":"Incal bx eyelid skn lid mrgn","description":"Incisional biopsy of eyelid skin including lid margin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57260","name":"Cmbn ant pst colprhy","description":"Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0215","name":"Electric heat pad moist","description":"Electric heat pad, moist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85547","name":"Rbc mechanical fragility","description":"Mechanical fragility, rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53425","name":"Reconstruct urethra stage 2","description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":757.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15841","name":"Nerve palsy muscle graft","description":"Graft for facial nerve paralysis; free muscle graft (including obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33690","name":"Banding pulmonary artery","description":"Banding of pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78433","name":"Myocrd img pet 2rtracer ct","description":"Myocardial imaging, positron emission tomography (pet), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35207","name":"Rpr bld vsl dir hand finger","description":"Repair blood vessel, direct; hand, finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17286","name":"Dstr mal ls f/e/e/n/l/m>4.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":219.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7400","name":"Add ue prost be/wd, ultlite","description":"Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43800","name":"Pyloroplasty","description":"Pyloroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":780.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01638","name":"Anes opn/arthr tot sho rplcm","description":"Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15650","name":"Transfer skin pedicle flap","description":"Transfer, intermediate, of any pedicle flap (eg, abdomen to wrist, walking tube), any location","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58152","name":"Total hysterectomy","description":"Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, marshall-marchetti-krantz, burch)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86793","name":"Yersinia antibody","description":"Antibody; yersinia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47142","name":"Partial removal donor liver","description":"Donor hepatectomy (including cold preservation), from living donor; total right lobectomy (segments v, vi, vii and viii)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3968.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80192","name":"Assay of procainamide","description":"Procainamide; with metabolites (eg, n-acetyl procainamide)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43122","name":"Partial removal of esophagus","description":"Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with esophagogastrostomy, with or without pyloroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0291","name":"Hosp bed fx ht w/o rail w/o","description":"Hospital bed, fixed height, without side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36907","name":"Balo angiop ctr dialysis seg","description":"Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90876","name":"Psychophysiological therapy","description":"Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81274","name":"Htt gene charac alleles","description":"Htt (huntingtin) (eg, huntington disease) gene analysis; characterization of alleles (eg, expanded size)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4648","name":"Implantable tissue marker","description":"Tissue marker, implantable, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25645","name":"Optx crpl fx oth/thn scph ea","description":"Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0239","name":"Oth resp proc, group","description":"Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11442","name":"Exc face-mm b9+marg 1.1-2 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35883","name":"Revj fem anast nonautog grf","description":"Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, polyester, eptfe, bovine pericardium)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1058.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11313","name":"Shave skin lesion >2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36820","name":"Av fusion/forearm vein","description":"Arteriovenous anastomosis, open; by forearm vein transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61791","name":"Treat trigeminal tract","description":"Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15933","name":"Exc sac pr ulc prim str ostc","description":"Excision, sacral pressure ulcer, with primary suture; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37226","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5007.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83055","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55876","name":"Place rt device/marker pros","description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67800","name":"Remove eyelid lesion","description":"Excision of chalazion; single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31631","name":"Bronchoscopy dilate w/stent","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53449","name":"Repair uro sphincter","description":"Repair of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0304","name":"Hosp bed xtra hvy dty x wide","description":"Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62273","name":"Inject epidural patch","description":"Injection, epidural, of blood or clot patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2132","name":"Kafo femoral fx cast soft","description":"Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":501.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21465","name":"Optx mndblr cndylr fx","description":"Open treatment of mandibular condylar fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27508","name":"Treatment of thigh fracture","description":"Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31652","name":"Bronch ebus samplng 1/2 node","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95965","name":"Meg spontaneous","description":"Magnetoencephalography (meg), recording and analysis; for spontaneous brain magnetic activity (eg, epileptic cerebral cortex localization)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64610","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0109T","name":"Heat quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using heat-pain stimuli to assess small nerve fiber sensation and hyperalgesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11981","name":"Insertion drug dlvr implant","description":"Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43337","name":"Thorabd diaphr hern repair","description":"Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30320","name":"Remove nasal foreign body","description":"Removal foreign body, intranasal; by lateral rhinotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36140","name":"Intro ndl icath upr/lxtr art","description":"Introduction of needle or intracatheter, upper or lower extremity artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6711","name":"Ped term dev, hook, vol open","description":"Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83026","name":"Hemoglobin copper sulfate","description":"Hemoglobin; by copper sulfate method, non-automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61635","name":"Intracran angioplsty w/stent","description":"Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1263.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96370","name":"Sc ther infusion addl hr","description":"Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66625","name":"Removal of iris","description":"Iridectomy, with corneoscleral or corneal section; peripheral for glaucoma (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1270","name":"Abdominal pad","description":"Addition to tlso, (low profile), abdominal pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44139","name":"Mobilization of colon","description":"Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63303","name":"Remov vert xdrl bdy lmbr/sac","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, lumbar or sacral by transperitoneal or retroperitoneal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01522","name":"Anes px vn lwr leg ven thrmb","description":"Anesthesia for procedures on veins of lower leg; venous thrombectomy, direct or with catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4100","name":"Repl leath cuff kafo prox th","description":"Replace leather cuff kafo, proximal thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44384","name":"Small bowel endoscopy","description":"Ileoscopy, through stoma; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2116","name":"Afo tibial fracture rigid","description":"Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35081","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1525.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5020","name":"Tibial tubercle hgt w/ toe f","description":"Partial foot, molded socket, tibial tubercle height, with toe filler","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5514","name":"Mult den insert dir carv/cam","description":"For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patients foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes ar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95811","name":"Polysom 6/>yrs cpap 4/> parm","description":"Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97168","name":"Ot re-eval est plan care","description":"Re-evaluation of occupational therapy established plan of care, requiring these components: an assessment of changes in patient functional or medical status with revised plan of care; an update to the initial occupational profile to reflect changes in condition or environment that affect future inte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93603","name":"Right ventricular recording","description":"Right ventricular recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76975","name":"Gi endoscopic ultrasound","description":"Gastrointestinal endoscopic ultrasound, supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69632","name":"Rebuild eardrum structures","description":"Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":869.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8460","name":"Shrinker above knee","description":"Prosthetic shrinker, above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3931","name":"Whfo nontorsion joint prefab","description":"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27532","name":"Treat knee fracture","description":"Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":517.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66825","name":"Reposition intraocular lens","description":"Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47531","name":"Injection for cholangiogram","description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25260","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":526.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69535","name":"Remove part of temporal bone","description":"Resection temporal bone, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00528","name":"Anes clsd ch mediast&thrc wo","description":"Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy not utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84485","name":"Assay duodenal fluid trypsin","description":"Trypsin; duodenal fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81179","name":"Atxn2 gene detc abnor allele","description":"Atxn2 (ataxin 2) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8914","name":"Mra w/o fol w/cont, lwr ext","description":"Magnetic resonance angiography without contrast followed by with contrast, lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65140","name":"Attach ocular implant","description":"Insertion of ocular implant secondary; after enucleation, muscles attached to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0504","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83892","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93306","name":"Tte w/doppler complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64570","name":"Remove vagus n eltrd","description":"Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21079","name":"Impres&prep intrm obt prosth","description":"Impression and custom preparation; interim obturator prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33411","name":"Replacement of aortic valve","description":"Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2929.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33218","name":"Repair lead pace-defib one","description":"Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78013","name":"Thyroid imaging w/blood flow","description":"Thyroid imaging (including vascular flow, when performed);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74150","name":"Ct abdomen w/o contrast","description":"Computed tomography, abdomen; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43101","name":"Excision of esophagus lesion","description":"Excision of lesion, esophagus, with primary repair; thoracic or abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94781","name":"Cars/bd tst inft-12mo +30min","description":"Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; each additional full 30 minutes (list separately in addition to code","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4205","name":"Ortho dvc repair per 15 min","description":"Repair of orthotic device, labor component, per 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50825","name":"Construct bowel bladder","description":"Continent diversion, including intestine anastomosis using any segment of small and/or large intestine (kock pouch or camey enterocystoplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01382","name":"Anes dx arthrs px knee jt","description":"Anesthesia for diagnostic arthroscopic procedures of knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0863","name":"Pwc gp3 vhd mult pow opt s/b","description":"Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81005","name":"Urinalysis","description":"Urinalysis; qualitative or semiquantitative, except immunoassays","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64566","name":"Neuroeltrd stim post tibial","description":"Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80418","name":"Pituitary evaluation panel","description":"Combined rapid anterior pituitary evaluation panel this panel must include the following: adrenocorticotropic hormone (acth) (82024 x 4) luteinizing hormone (lh) (83002 x 4) follicle stimulating hormone (fsh) (83001 x 4) prolactin (84146 x 4) human growth hormone (hgh) (83003 x 4) cortisol (82533 x ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42870","name":"Excision of lingual tonsil","description":"Excision or destruction lingual tonsil, any method (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52287","name":"Cystoscopy chemodenervation","description":"Cystourethroscopy, with injection(s) for chemodenervation of the bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0733","name":"12-24hr sealed lead acid","description":"Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63046","name":"Lam facetec & foramot thrc","description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2380","name":"Torsion straight knee joint","description":"Addition to lower extremity, torsion control, straight knee joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29898","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23525","name":"Cltx strnclav dislc w/mnpj","description":"Closed treatment of sternoclavicular dislocation; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4346","name":"Cath indw foley 3 way","description":"Indwelling catheter; foley type, three way for continuous irrigation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42972","name":"Control nose/throat bleeding","description":"Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); with secondary surgical intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73501","name":"X-ray exam hip uni 1 view","description":"Radiologic examination, hip, unilateral, with pelvis when performed; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81439","name":"Hrdtry cardmypy gene panel","description":"Hereditary cardiomyopathy (eg, hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy), genomic sequence analysis panel, must include sequencing of at least 5 cardiomyopathy-related genes (eg, dsg2, mybpc3, myh7, pkp2, ttn)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0001A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50045","name":"Nephrotomy w/exploration","description":"Nephrotomy, with exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54380","name":"Repair penis","description":"Plastic operation on penis for epispadias distal to external sphincter;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":647.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43277","name":"Ercp ea duct/ampulla dilate","description":"Endoscopic retrograde cholangiopancreatography (ercp); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1092","name":"Wheelchair wide w/ leg rests","description":"Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21700","name":"Revision of neck muscle","description":"Division of scalenus anticus; without resection of cervical rib","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99494","name":"1st/sbsq psyc collab care","description":"Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (list separa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86357","name":"Nk cells total count","description":"Natural killer (nk) cells, total count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2525","name":"Th/wght bear nar m-l brim mo","description":"Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99498","name":"Advncd care plan addl 30 min","description":"Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (list separately in addition to code for primary proce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5975","name":"Combo ankle/foot prosthesis","description":"All lower extremity prosthesis, combination single axis ankle and flexible keel foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5848","name":"Knee-shin sys hydraul stance","description":"Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":524.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0812","name":"Power operated vehicle noc","description":"Power operated vehicle, not otherwise classified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99214","name":"Office o/p est mod 30 min","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70150","name":"X-ray exam of facial bones","description":"Radiologic examination, facial bones; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33641","name":"Repair heart septum defect","description":"Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or without patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76377","name":"3d render w/intrp postproces","description":"3d rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42804","name":"Biopsy of upper nose/throat","description":"Biopsy; nasopharynx, visible lesion, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95938","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95115","name":"Immunotherapy one injection","description":"Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27067","name":"Remove/graft hip bone lesion","description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; with autograft requiring separate incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":875.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0340","name":"Robt lin-radsurg fractx 2-5","description":"Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54130","name":"Remove penis & nodes","description":"Amputation of penis, radical; with bilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":965.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0610","name":"Pacemaker monitr audible/vis","description":"Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31574","name":"Largsc w/njx augmentation","description":"Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36563","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device with subcutaneous pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":981.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3410","name":"Shoe metatarsal bar between","description":"Metatarsal bar wedge, between sole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00862","name":"Anes xtrprtl lwr abd rnl px","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one-third of ureter, or donor nephrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95714","name":"Veeg ea 12-26 hr unmntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, each increment of 12-26 hours; unmonitored","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33259","name":"Ablate atria w/bypass add-on","description":"Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), with cardiopulmonary bypass (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":727.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82715","name":"Assay of fecal fat","description":"Fat differential, feces, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0008","name":"Admin influenza virus vac","description":"Administration of influenza virus vaccine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44340","name":"Revision of colostomy","description":"Revision of colostomy; simple (release of superficial scar) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28525","name":"Treat toe fracture","description":"Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":466.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20938","name":"Sp bone agrft struct add-on","description":"Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86021","name":"Wbc antibody identification","description":"Antibody identification; leukocyte antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92652","name":"Aep thrshld est mlt freq i&r","description":"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93227","name":"Xtrnl ecg rec<48 hr r&i","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31601","name":"Planned tracheostomy<2 yrs","description":"Tracheostomy, planned (separate procedure); younger than 2 years","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9482","name":"Remote e/m new pt 20mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination;  straightforward medical decis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0076T","name":"S&i stent/chest vert art","description":"Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; each additional vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20500","name":"Njx sinus tract therapeutic","description":"Injection of sinus tract; therapeutic (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54390","name":"Repair penis and bladder","description":"Plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1004.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88182","name":"Cell marker study","description":"Flow cytometry, cell cycle or dna analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25240","name":"Partial removal of ulna","description":"Excision distal ulna partial or complete (eg, darrach type or matched resection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19081","name":"Bx breast 1st lesion strtctc","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":376.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0337","name":"Hospice evaluation preelecti","description":"Hospice evaluation and counseling services, pre-election","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59871","name":"Remove cerclage suture","description":"Removal of cerclage suture under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87490","name":"Chlmyd trach dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia trachomatis, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1014","name":"Reclining back add ped w/c","description":"Reclining back, addition to pediatric size wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4524","name":"Adult size brief/diaper xl","description":"Adult sized disposable incontinence product, brief/diaper, extra large, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01652","name":"Anes art sho&ax ax-brch arsm","description":"Anesthesia for procedures on arteries of shoulder and axilla; axillary-brachial aneurysm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20902","name":"Removal of bone for graft","description":"Bone graft, any donor area; major or large","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76818","name":"Fetal biophys profile w/nst","description":"Fetal biophysical profile; with non-stress testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01274","name":"Anes px art fem art emblc","description":"Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery embolectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78584","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82120","name":"Amines vaginal fluid qual","description":"Amines, vaginal fluid, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77078","name":"Ct bone density axial","description":"Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11721","name":"Debride nail 6 or more","description":"Debridement of nail(s) by any method(s); 6 or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35341","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; mesenteric, celiac, or renal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23921","name":"Disarticulation sho sec clsr","description":"Disarticulation of shoulder; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93890","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63003","name":"Remove spine lamina 1/2 thrc","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27307","name":"Incision of thigh tendons","description":"Tenotomy, percutaneous, adductor or hamstring; multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25505","name":"Cltx rdl shft fx w/mnpj","description":"Closed treatment of radial shaft fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":420.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28100","name":"Removal of ankle/heel lesion","description":"Excision or curettage of bone cyst or benign tumor, talus or calcaneus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":500.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0140","name":"Nav srv peer sup 60 min pr m","description":"Principal illness navigation - peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities:  person-centered interview, performed to better underst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34101","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33258","name":"Ablate atria x10sv add-on","description":"Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), without cardiopulmonary bypass (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35351","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; iliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51840","name":"Attach bladder/urethra","description":"Anterior vesicourethropexy, or urethropexy (eg, marshall-marchetti-krantz, burch); simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":557.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7001","name":"Nondisposable pump canister","description":"Canister, non-disposable, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27641","name":"Partial removal of fibula","description":"Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":549.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01938","name":"Anes drg/aspir lmbr/sac","description":"Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37215","name":"Transcath stent cca w/eps","description":"Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":874.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88173","name":"Cytopath eval fna report","description":"Cytopathology, evaluation of fine needle aspirate; interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6254","name":"Absorpt drg <=16 sq in w/bdr","description":"Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99495","name":"Transj care mgmt mod f2f 14d","description":"Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge at least moderate level of medical decision making during the service period face-to-face visit, wit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5054","name":"Clsd ostomy pouch w/flange","description":"Ostomy pouch, closed; for use on barrier with flange (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26357","name":"Repair finger/hand tendon","description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no mans land); secondary, without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":747.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64755","name":"Incision of stomach nerves","description":"Transection or avulsion of; vagus nerves limited to proximal stomach (selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33600","name":"Closure of valve","description":"Closure of atrioventricular valve (mitral or tricuspid) by suture or patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92511","name":"Nasopharyngoscopy","description":"Nasopharyngoscopy with endoscope (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29805","name":"Sho arthrs dx +- synovial bx","description":"Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46607","name":"Diagnostic anoscopy & biopsy","description":"Anoscopy; with high-resolution magnification (hra) (eg, colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0301","name":"Hd hosp bed, 350-600 lbs","description":"Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47701","name":"Bile duct revision","description":"Portoenterostomy (eg, kasai procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1457.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27120","name":"Reconstruction of hip socket","description":"Acetabuloplasty; (eg, whitman, colonna, haygroves, or cup type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1101.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80101","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23625","name":"Cltx gr hmrl tbrs fx w/mnpj","description":"Closed treatment of greater humeral tuberosity fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70010","name":"Contrast x-ray of brain","description":"Myelography, posterior fossa, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58280","name":"Hysterectomy/revise vagina","description":"Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":679.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6241","name":"Hydrocolloid drg filler dry","description":"Hydrocolloid dressing, wound filler, dry form, sterile, per gram","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83051","name":"Hemoglobin plasma","description":"Hemoglobin; plasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73723","name":"Mri joint lwr extr w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82671","name":"Assay of estrogens","description":"Estrogens; fractionated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4258","name":"Lancet device each","description":"Spring-powered device for lancet, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11720","name":"Debride nail 1-5","description":"Debridement of nail(s) by any method(s); 1 to 5","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68510","name":"Biopsy of tear gland","description":"Biopsy of lacrimal gland","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":277.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30410","name":"Reconstruction of nose","description":"Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5711","name":"Knee-shin exo mnl lock ultra","description":"Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1730","name":"Legg perthes orth scottish r","description":"Legg perthes orthosis, (scottish rite type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54336","name":"Revise penis/urethra","description":"1-stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":962.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6624","name":"Flex/ext/rotation wrist unit","description":"Upper extremity addition, flexion/extension and rotation wrist unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1834.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75989","name":"Abscess drainage under x-ray","description":"Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92518","name":"Vemp test i&r ocular","description":"Vestibular evoked myogenic potential (vemp) testing, with interpretation and report; ocular (ovemp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73222","name":"Mri joint upr extrem w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87451","name":"Polyvalent mult org ea ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; polyvalent for multiple organisms, each polyvalent antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61684","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; infratentorial, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61320","name":"Crnec/crnot drg icr abs sttl","description":"Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1736.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42665","name":"Ligation of salivary duct","description":"Ligation salivary duct, intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2360","name":"Extended steel shank","description":"Addition to lower extremity, extended steel shank","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42961","name":"Control throat bleeding","description":"Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); complicated, requiring hospitalization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76983","name":"Use ea addl target lesion","description":"Ultrasound, elastography; each additional target lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33266","name":"Ablate atria x10sv endo","description":"Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1602.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25360","name":"Revision of ulna","description":"Osteotomy; ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":547.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88309","name":"Tissue exam by pathologist","description":"Level vi - surgical pathology, gross and microscopic examination bone resection breast, mastectomy - with regional lymph nodes colon, segmental resection for tumor colon, total resection esophagus, partial/total resection extremity, disarticulation fetus, with dissection larynx, partial/total resect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28475","name":"Cltx metatarsal fx w/mnpj ea","description":"Closed treatment of metatarsal fracture; with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91030","name":"Acid perfusion of esophagus","description":"Esophagus, acid perfusion (bernstein) test for esophagitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48150","name":"Partial removal of pancreas","description":"Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (whipple-type procedure); with pancreatojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2609.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11406","name":"Exc tr-ext b9+marg >4.0 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64561","name":"Implant neuroelectrodes","description":"Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76820","name":"Umbilical artery echo","description":"Doppler velocimetry, fetal; umbilical artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23500","name":"Cltx clavicular fx w/o mnpj","description":"Closed treatment of clavicular fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83550","name":"Iron binding test","description":"Iron binding capacity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62264","name":"Epidural lysis on single day","description":"Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43279","name":"Lap myotomy heller","description":"Laparoscopy, surgical, esophagomyotomy (heller type), with fundoplasty, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1076.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60270","name":"Removal of thyroid","description":"Thyroidectomy, including substernal thyroid; sternal split or transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1158.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2232","name":"Rocker bottom, contact afo","description":"Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95958","name":"Eeg monitoring/function test","description":"Wada activation test for hemispheric function, including electroencephalographic (eeg) monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11046","name":"Dbrdmt musc&/fsca ea addl","description":"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27630","name":"Removal of tendon lesion","description":"Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2387","name":"Foam filled caster tire","description":"Power wheelchair accessory, foam filled caster tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64905","name":"Nerve pedicle transfer","description":"Nerve pedicle transfer; first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64895","name":"Nrv grf mltst hnd/foot <4 cm","description":"Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1127.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82810","name":"Blood gases o2 sat only","description":"Gases, blood, o2 saturation only, by direct measurement, except pulse oximetry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21076","name":"Impres&prep surg obt prosth","description":"Impression and custom preparation; surgical obturator prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":717.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45820","name":"Repair rectourethral fistula","description":"Closure of rectourethral fistula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58760","name":"Fimbrioplasty","description":"Fimbrioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33820","name":"Repair pda by ligation","description":"Repair of patent ductus arteriosus; by ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86320","name":"Serum immunoelectrophoresis","description":"Immunoelectrophoresis; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38790","name":"Inject for lymphatic x-ray","description":"Injection procedure; lymphangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14060","name":"Tis trnfr e/n/e/l 10 sq cm/<","description":"Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6628","name":"Quick disconn hook adapter o","description":"Upper extremity addition, quick disconnect hook adapter, otto bock or equal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46922","name":"Excision of anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":230.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78725","name":"Kidney function study","description":"Kidney function study, non-imaging radioisotopic study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86807","name":"Cytotoxic antibody screening","description":"Serum screening for cytotoxic percent reactive antibody (pra); standard method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70260","name":"X-ray exam of skull","description":"Radiologic examination, skull; complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15853","name":"Removal sutr/stapl xreq anes","description":"Removal of sutures or staples not requiring anesthesia (list separately in addition to e/m code)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29834","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":413.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27524","name":"Treat kneecap fracture","description":"Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":634.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27416","name":"Osteochondral knee autograft","description":"Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44145","name":"Partial removal of colon","description":"Colectomy, partial; with coloproctostomy (low pelvic anastomosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1357.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66020","name":"Injection treatment of eye","description":"Injection, anterior chamber of eye (separate procedure); air or liquid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23931","name":"I&d upr a/e bursa","description":"Incision and drainage, upper arm or elbow area; bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75889","name":"Vein x-ray liver w/hemodynam","description":"Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45395","name":"Lap removal of rectum","description":"Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1572.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8100","name":"Spacer without mask","description":"Holding chamber or spacer for use with an inhaler or nebulizer; without mask","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33910","name":"Remove lung artery emboli","description":"Pulmonary artery embolectomy; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77522","name":"Proton trmt simple w/comp","description":"Proton treatment delivery; simple, with compensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":592.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89330","name":"Evaluation cervical mucus","description":"Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19001","name":"Puncture aspir cyst brst ea","description":"Puncture aspiration of cyst of breast; each additional cyst (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43887","name":"Gstr rstcv px opn rmvl port","description":"Gastric restrictive procedure, open; removal of subcutaneous port component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12041","name":"Intmd rpr n-hf/genit 2.5cm/<","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45334","name":"Sigmoidoscopy for bleeding","description":"Sigmoidoscopy, flexible; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27530","name":"Treat knee fracture","description":"Closed treatment of tibial fracture, proximal (plateau); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70120","name":"X-ray exam of mastoids","description":"Radiologic examination, mastoids; less than 3 views per side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75716","name":"Artery x-rays arms/legs","description":"Angiography, extremity, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5940","name":"Endo bk ultra-light material","description":"Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31075","name":"Exploration of frontal sinus","description":"Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, lynch type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":599.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0639","name":"Lso s/c shell/panel prefab","description":"Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by ove","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96170","name":"Hlth bhv ivntj fam wo pt 1st","description":"Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75833","name":"Vein x-ray kidneys","description":"Venography, renal, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4520","name":"Incontinence garment anytype","description":"Incontinence garment, any type, (e.g., brief, diaper), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77074","name":"Radex osseous survey lmtd","description":"Radiologic examination, osseous survey; limited (eg, for metastases)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94450","name":"Breathing response hypoxia","description":"Breathing response to hypoxia (hypoxia response curve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83925","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90823","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82390","name":"Assay of ceruloplasmin","description":"Ceruloplasmin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96116","name":"Nubhvl xm phys/qhp 1st hr","description":"Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99340","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66988","name":"Xcapsl ctrc rmvl w/ecp","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57107","name":"Vagnc compl rmvl paravag tis","description":"Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97024","name":"Diathermy eg microwave","description":"Application of a modality to 1 or more areas; diathermy (eg, microwave)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74300","name":"X-ray bile ducts/pancreas","description":"Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76098","name":"X-ray exam surgical specimen","description":"Radiological examination, surgical specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86654","name":"Encephaltis west eqne antbdy","description":"Antibody; encephalitis, western equine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28476","name":"Prq skel fix metar fx w/mnpj","description":"Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42800","name":"Biopsy of throat","description":"Biopsy; oropharynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2600","name":"Hip clevis/thrust bearing fr","description":"Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27552","name":"Treat knee dislocation","description":"Closed treatment of knee dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":529.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92312","name":"Contact lens fitg aphakia ou","description":"Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, both eyes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95875","name":"Limb exercise test","description":"Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6544","name":"Gc stocking garter belt","description":"Gradient compression stocking, garter belt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29844","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; synovectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94762","name":"N-invas ear/pls oximtry cont","description":"Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84379","name":"Sugars multiple quant","description":"Sugars (mono-, di-, and oligosaccharides); multiple quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29851","name":"Knee arthroscopy/surgery","description":"Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68760","name":"Close tear duct opening","description":"Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87482","name":"Candida dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); candida species, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24120","name":"Exc/crtg b1 cst/b9 tum rds","description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4639","name":"Infrared ht sys replcmnt pad","description":"Replacement pad for infrared heating pad system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99155","name":"Mod sed oth phys/qhp <5 yrs","description":"Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35703","name":"Expl n/flwd surg lxtr art","description":"Exploration not followed by surgical repair, artery; lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial, peroneal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0607","name":"Blood glucose monitor home","description":"Home blood glucose monitor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33968","name":"Remove aortic assist device","description":"Removal of intra-aortic balloon assist device, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64620","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, intercostal nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28293","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":827.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11755","name":"Biopsy nail unit","description":"Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00902","name":"Anes anorectal px","description":"Anesthesia for; anorectal procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77332","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; simple (simple block, simple bolus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87118","name":"Mycobacteric identification","description":"Culture, mycobacterial, definitive identification, each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48146","name":"Pancreatectomy","description":"Pancreatectomy, distal, near-total with preservation of duodenum (child-type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1577.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76513","name":"Oph us dx ant sgm us uni/bi","description":"Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) b-scan or high resolution biomicroscopy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93931","name":"Upper extremity study","description":"Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90471","name":"Immunization admin","description":"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3976","name":"Sewhfo airplane w/o jnts cf","description":"Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0776","name":"Iv pole","description":"Iv pole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","BA","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33852","name":"Rpr hypopl a-arch wo byp","description":"Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10035","name":"Plmt sft tiss loclzj dev 1st","description":"Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27181","name":"Treat slipped epiphysis","description":"Open treatment of slipped femoral epiphysis; osteotomy and internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50500","name":"Repair of kidney wound","description":"Nephrorrhaphy, suture of kidney wound or injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95115","name":"Immunotherapy one injection","description":"Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15136","name":"Drm agrft f/s/n/h/f/g/m ea","description":"Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36405","name":"Vnpnxr<3yrs phy/qhp scalp vn","description":"Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; scalp vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6540","name":"Gc stocking waistlngth 30-40","description":"Gradient compression stocking, waist length, 30-40 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88185","name":"Flowcytometry/tc add-on","description":"Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (list separately in addition to code for first marker)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27093","name":"Injection for hip x-ray","description":"Injection procedure for hip arthrography; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54348","name":"Rpr hypspad comp dsj & urtp","description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); requiring extensive dissection, and urethroplasty with flap, patch or tubed graft (including urinary diversion, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":818.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62200","name":"Establish brain cavity shunt","description":"Ventriculocisternostomy, third ventricle;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44661","name":"Repair bowel-bladder fistula","description":"Closure of enterovesical fistula; with intestine and/or bladder resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1270.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29916","name":"Hip arthro w/labral repair","description":"Arthroscopy, hip, surgical; with labral repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":863.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99143","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42806","name":"Biopsy of upper nose/throat","description":"Biopsy; nasopharynx, survey for unknown primary lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24615","name":"Optx aqt/chrnc elbow dislc","description":"Open treatment of acute or chronic elbow dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92242","name":"Fluorescein&icg angiography","description":"Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15819","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61613","name":"Remove aneurysm sinus","description":"Obliteration of carotid aneurysm, arteriovenous malformation, or carotid-cavernous fistula by dissection within cavernous sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3017.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15945","name":"Exc isch pr ulc skn flp ostc","description":"Excision, ischial pressure ulcer, with skin flap closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":652.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0952","name":"Toe loop/holder, each","description":"Toe loop/holder, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5053","name":"Clsd ostomy pouch faceplate","description":"Ostomy pouch, closed; for use on faceplate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0456","name":"Tlso flex trnk sj-ss pre cst","description":"Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on t","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80502","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21339","name":"Open nasoethmoid fx w/ fixj","description":"Open treatment of nasoethmoid fracture; with external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51865","name":"Repair of bladder wound","description":"Cystorrhaphy, suture of bladder wound, injury or rupture; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95717","name":"Eeg phys/qhp 2-12 hr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report, 2-12 hours of eeg recording; without video","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44378","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26340","name":"Manipulate finger w/anesth","description":"Manipulation, finger joint, under anesthesia, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":281.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96102","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0480","name":"Tlso rigid plastic custom fa","description":"Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, res","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":801.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49460","name":"Fix g/colon tube w/device","description":"Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed, image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":564.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56501","name":"Destroy vulva lesions sim","description":"Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39561","name":"Resect diaphragm complex","description":"Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85549","name":"Muramidase","description":"Muramidase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28086","name":"Excise foot tendon sheath","description":"Synovectomy, tendon sheath, foot; flexor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97598","name":"Dbrdmt opn wnd addl 20cm/<","description":"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when perform","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54115","name":"Treatment of penis lesion","description":"Removal foreign body from deep penile tissue (eg, plastic implant)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":367.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71270","name":"Ct thorax dx c-/c+","description":"Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61556","name":"Incise skull/sutures","description":"Craniotomy for craniosynostosis; frontal or parietal bone flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33202","name":"Insert epicard eltrd open","description":"Insertion of epicardial electrode(s); open incision (eg, thoracotomy, median sternotomy, subxiphoid approach)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":667.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67938","name":"Remove eyelid foreign body","description":"Removal of embedded foreign body, eyelid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2609","name":"Custom fabricate w/c cushion","description":"Custom fabricated wheelchair seat cushion, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36570","name":"Insert picvad cath","description":"Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22859","name":"Insj biomechanical device","description":"Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":301.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2630","name":"Pelvic control band & belt u","description":"Addition to lower extremity, pelvic control, band and belt, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97166","name":"Ot eval mod complex 45 min","description":"Occupational therapy evaluation, moderate complexity, requiring these components: an occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current func","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64405","name":"Njx aa&/strd gr ocpl nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"UNK","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":80.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":64.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":79.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":96.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":153.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":72.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83835","name":"Assay of metanephrines","description":"Metanephrines","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29904","name":"Subtalar arthro w/fb rmvl","description":"Arthroscopy, subtalar joint, surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34421","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by leg incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":399.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2009","name":"Post-d/c h vst ext pt 60 m","description":"Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatien","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72114","name":"X-ray exam l-s spine bending","description":"Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76825","name":"Echo exam of fetal heart","description":"Echocardiography, fetal, cardiovascular system, real time with image documentation (2d), with or without m-mode recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":214.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00470","name":"Anes partial rib rescj nos","description":"Anesthesia for partial rib resection; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78597","name":"Lung perfusion differential","description":"Quantitative differential pulmonary perfusion, including imaging when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27881","name":"Amputation of lower leg","description":"Amputation, leg, through tibia and fibula; with immediate fitting technique including application of first cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":736.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64681","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2784","name":"Lens polycarb or equal","description":"Lens, polycarbonate or equal, any index, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77081","name":"Dxa bone density appendiculr","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33917","name":"Repair pulmonary artery","description":"Repair of pulmonary artery stenosis by reconstruction with patch or graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1261.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0268","name":"Removal of impacted wax md","description":"Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23400","name":"Fixation of shoulder blade","description":"Scapulopexy (eg, sprengels deformity or for paralysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":822.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87110","name":"Chlamydia culture","description":"Culture, chlamydia, any source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2315","name":"Lens lenticular trifocal","description":"Lenticular, (myodisc), per lens, trifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36860","name":"External cannula declotting","description":"External cannula declotting (separate procedure); without balloon catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":206.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0283","name":"Elec stim other than wound","description":"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21195","name":"Reconst lwr jaw w/o fixation","description":"Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1099.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01740","name":"Anes opn/arthrs px elbw nos","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6672","name":"Harness chest/shlder saddle","description":"Upper extremity addition, harness, chest or shoulder, saddle type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4461","name":"Surgicl dress hold non-reuse","description":"Surgical dressing holder, non-reusable, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21812","name":"Treatment of rib fracture","description":"Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 4-6 ribs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95827","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":410.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35721","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37760","name":"Lig prfratr vn radical 1 leg","description":"Ligation of perforator veins, subfascial, radical (linton type), including skin graft, when performed, open,1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45392","name":"Colonoscopy w/endoscopic fnb","description":"Colonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8320","name":"Truss addition to std pad wa","description":"Truss, addition to standard pad, water pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38308","name":"Incision of lymph channels","description":"Lymphangiotomy or other operations on lymphatic channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4930","name":"Sterile, gloves per pair","description":"Gloves, sterile, per pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5706","name":"Custom shape cvr knee disart","description":"Custom shaped protective cover, knee disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73701","name":"Ct lower extremity w/dye","description":"Computed tomography, lower extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43763","name":"Rplc gtube revj gstrst trc","description":"Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0040","name":"Adjustable angle footplate","description":"Adjustable angle footplate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0076T","name":"S&i stent/chest vert art","description":"Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; each additional vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":686.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64712","name":"Revision of sciatic nerve","description":"Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":495.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90849","name":"Multiple family group psytx","description":"Multiple-family group psychotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20926","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7520","name":"Trach/laryn tube non-cuffed","description":"Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21256","name":"Reconstruction of orbit","description":"Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1042.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54420","name":"Revision of penis","description":"Corpora cavernosa-saphenous vein shunt (priapism operation), unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":569.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33741","name":"Tas congenital car anomal","description":"Transcatheter atrial septostomy (tas) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, rashkind, sang-park, balloon, cutting balloon, blade)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":661.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47561","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":239.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35525","name":"Art byp grft brachial-brchl","description":"Bypass graft, with vein; brachial-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":999.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4537","name":"Reusable underpad bed size","description":"Incontinence product, protective underpad, reusable, bed size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0292","name":"Hosp bed var ht no sr w/matt","description":"Hospital bed, variable height, hi-lo, without side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87110","name":"Chlamydia culture","description":"Culture, chlamydia, any source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1730","name":"Cath, ep, 19 or few elect","description":"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81000","name":"Urinalysis nonauto w/scope","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","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83670","name":"Assay of lap enzyme","description":"Leucine aminopeptidase (lap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81007","name":"Urine screen for bacteria","description":"Urinalysis; bacteriuria screen, except by culture or dipstick","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31638","name":"Bronchoscopy revise stent","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as required)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0317","name":"Prolong nursin fac eval 15m","description":"Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88108","name":"Cytopath concentrate tech","description":"Cytopathology, concentration technique, smears and interpretation (eg, saccomanno technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93792","name":"Pt/caregiver traing home inr","description":"Patient/caregiver training for initiation of home international normalized ratio (inr) monitoring under the direction of a physician or other qualified health care professional, face-to-face, including use and care of the inr monitor, obtaining blood sample, instructions for reporting home inr test ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15820","name":"Blepharoplasty lower eyelid","description":"Blepharoplasty, lower eyelid;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61539","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, with electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2168.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0730","name":"Tens four lead","description":"Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54901","name":"Fusion of spermatic ducts","description":"Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3977","name":"Sewhfo cap desgn w/jnt(s) cf","description":"Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11600","name":"Exc tr-ext mal+marg 0.5 cm/<","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99345","name":"Home/res vst new high mdm 75","description":"Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38305","name":"Drainage lymph node lesion","description":"Drainage of lymph node abscess or lymphadenitis; extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22848","name":"Insert pelv fixation device","description":"Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19396","name":"Design custom breast implant","description":"Preparation of moulage for custom breast implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01480","name":"Anes open px lower l/a/f nos","description":"Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99486","name":"Suprv interfac trnsport addl","description":"Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data inter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59030","name":"Fetal scalp blood sampling","description":"Fetal scalp blood sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0460","name":"Autolog prp not diab ulcer","description":"Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26140","name":"Revise finger joint each","description":"Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":421.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33845","name":"Excision coa w/graft","description":"Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5781","name":"Lower limb pros vacuum pump","description":"Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1949.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83020","name":"Hemoglobin electrophoresis","description":"Hemoglobin fractionation and quantitation; electrophoresis (eg, a2, s, c, and/or f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01712","name":"Anes px nrv msc upr a&e tnot","description":"Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenotomy, elbow to shoulder, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84446","name":"Assay of vitamin e","description":"Tocopherol alpha (vitamin e)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31365","name":"Removal of larynx","description":"Laryngectomy; total, with radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1925.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41116","name":"Excision of mouth lesion","description":"Excision, lesion of floor of mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":256.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01656","name":"Anes art sho&ax ax-fem bpg","description":"Anesthesia for procedures on arteries of shoulder and axilla; axillary-femoral bypass graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4082","name":"Enteral ng tubing w/o stylet","description":"Nasogastric tubing without stylet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22901","name":"Exc abdl tum deep 5 cm/>","description":"Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":576.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1300","name":"Body jacket mold to patient","description":"Other scoliosis procedure, body jacket molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15121","name":"Splt agrft f/s/n/h/f/g/m ea","description":"Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92570","name":"Acoustic immitance testing","description":"Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86617","name":"Lyme disease antibody","description":"Antibody; borrelia burgdorferi (lyme disease) confirmatory test (eg, western blot or immunoblot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87552","name":"Mycobacteria dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria species, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30200","name":"Injection treatment of nose","description":"Injection into turbinate(s), therapeutic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84311","name":"Spectrophotometry","description":"Spectrophotometry, analyte not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98977","name":"Rtm dev sply mscskl 16-30 d","description":"Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 16-30 days in a 30-day period","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85290","name":"Clot factor xiii fibrin stab","description":"Clotting; factor xiii (fibrin stabilizing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25270","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42510","name":"Parotid duct diversion","description":"Parotid duct diversion, bilateral (wilke type procedure); with ligation of both submandibular (whartons) ducts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":476.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26608","name":"Treat metacarpal fracture","description":"Percutaneous skeletal fixation of metacarpal fracture, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":399.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0144","name":"Scr c/v cyto,thinlayer,rescr","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32557","name":"Insert cath pleura w/ image","description":"Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24149","name":"Radical resection of elbow","description":"Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":985.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29740","name":"Wedging of cast","description":"Wedging of cast (except clubfoot casts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10005","name":"Fna bx w/us gdn 1st les","description":"Fine needle aspiration biopsy, including ultrasound guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1702","name":"Repl measr scales jaw motion","description":"Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92523","name":"Speech sound lang comprehen","description":"Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99231","name":"Sbsq hosp ip/obs sf/low 25","description":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. when using total time on the date of the encounter for code selec","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43762","name":"Rplc gtube no revj trc","description":"Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86658","name":"Enterovirus antibody","description":"Antibody; enterovirus (eg, coxsackie, echo, polio)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35400","name":"Angioscopy","description":"Angioscopy (noncoronary vessels or grafts) during therapeutic intervention (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0280","name":"Bed cradle","description":"Bed cradle, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92542","name":"Positional nystagmus test","description":"Positional nystagmus test, minimum of 4 positions, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86341","name":"Islet cell antibody","description":"Islet cell antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93005","name":"Electrocardiogram tracing","description":"Electrocardiogram, routine ecg with at least 12 leads; tracing only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63047","name":"Lam facetec & foramot lumbar","description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61140","name":"Burr hole/treph bx brain/les","description":"Burr hole(s) or trephine; with biopsy of brain or intracranial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0111","name":"Wet mounts/ w preparations","description":"Wet mounts, including preparations of vaginal, cervical or skin specimens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26548","name":"Reconstruct finger joint","description":"Repair and reconstruction, finger, volar plate, interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84030","name":"Assay of blood pku","description":"Phenylalanine (pku), blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27187","name":"Reinforce hip bones","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, femoral neck and proximal femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77423","name":"Neutron beam tx complex","description":"High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74249","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63172","name":"Drainage of spinal cyst","description":"Laminectomy with drainage of intramedullary cyst/syrinx; to subarachnoid space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1249.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11307","name":"Shave skin lesion 1.1-2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0019","name":"Arm pad repl, each","description":"Arm pad, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50562","name":"Renal scope w/tumor resect","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with resection of tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":468.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43255","name":"Egd control bleeding any","description":"Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":504.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99239","name":"Hosp ip/obs dschrg mgmt >30","description":"Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75953","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87661","name":"Trichomonas vaginalis amplif","description":"Infectious agent detection by nucleic acid (dna or rna); trichomonas vaginalis, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44364","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70450","name":"Ct head/brain w/o dye","description":"Computed tomography, head or brain; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93451","name":"Right heart cath","description":"Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4651","name":"Calibrated microcap tube","description":"Calibrated microcapillary tube, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4088","name":"Gastro/jejuno tube, low-pro","description":"Gastrostomy/jejunostomy tube, low-profile, any material, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76873","name":"Echograp trans r pros study","description":"Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25800","name":"Arthrd wrist complete wo grf","description":"Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99486","name":"Suprv interfac trnsport addl","description":"Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data inter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67027","name":"Implant eye drug system","description":"Implantation of intravitreal drug delivery system (eg, ganciclovir implant), includes concomitant removal of vitreous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":510.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21087","name":"Impres&prep nasal prosth","description":"Impression and custom preparation; nasal prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1318.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50728","name":"Revise ureter","description":"Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8310","name":"Truss double w/ standard pad","description":"Truss, double with standard pads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32608","name":"Thoracoscopy w/bx nodule","description":"Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38214","name":"Volume deplete of harvest","description":"Transplant preparation of hematopoietic progenitor cells; plasma (volume) depletion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96910","name":"Photchmtx tar&uvb/ptrltm&uvb","description":"Photochemotherapy; tar and ultraviolet b (goeckerman treatment) or petrolatum and ultraviolet b","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25426","name":"Repair/graft radius & ulna","description":"Repair of defect with autograft; radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43212","name":"Esophagoscop stent placement","description":"Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0860","name":"Pwc gp3 vhd sing pow opt s/b","description":"Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0127","name":"Trim nail(s)","description":"Trimming of dystrophic nails, any number","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12020","name":"Tx supfc wnd dehsn smpl clsr","description":"Treatment of superficial wound dehiscence; simple closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93724","name":"Elec alys antitchycar pm sys","description":"Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21360","name":"Opn tx dprsd malar fracture","description":"Open treatment of depressed malar fracture, including zygomatic arch and malar tripod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":415.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35647","name":"Bpg aortofemoral","description":"Bypass graft, with other than vein; aortofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1362.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4244","name":"Alcohol or peroxide per pint","description":"Alcohol or peroxide, per pint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90847","name":"Family psytx w/pt 50 min","description":"Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55720","name":"Drainage of prostate abscess","description":"Prostatotomy, external drainage of prostatic abscess, any approach; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75831","name":"Vein x-ray kidney","description":"Venography, renal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4615","name":"Cannula nasal","description":"Cannula, nasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4628","name":"Oropharyngeal suction cath","description":"Oral and/or oropharyngeal suction catheter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43501","name":"Surgical repair of stomach","description":"Gastrotomy; with suture repair of bleeding ulcer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61323","name":"Crnec/crnot dcmprv w/lobec","description":"Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; with lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93024","name":"Ergonovine provocation test","description":"Ergonovine provocation test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4527","name":"Adult size pull-on lg","description":"Adult sized disposable incontinence product, protective underwear/pull-on, large size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9561","name":"Tc99m oxidronate","description":"Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75746","name":"Artery x-rays lung","description":"Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24516","name":"Tx humrl shaft fx imed implt","description":"Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0247","name":"Trans bench w/wo comm open","description":"Transfer bench for tub or toilet with or without commode opening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94762","name":"N-invas ear/pls oximtry cont","description":"Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91133","name":"Electrogastrography w/test","description":"Electrogastrography, diagnostic, transcutaneous; with provocative testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":256.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93458","name":"L hrt artery/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5321","name":"Ak open end sach","description":"Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45990","name":"Surg dx exam anorectal","description":"Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35236","name":"Repair blvsl vn grf uxtr","description":"Repair blood vessel with vein graft; upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":874.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1087","name":"Wheelchair lightwt fixed arm","description":"High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54840","name":"Remove epididymis lesion","description":"Excision of spermatocele, with or without epididymectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1951","name":"Afo spiral prefab custom","description":"Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23330","name":"Remove shoulder foreign body","description":"Removal of foreign body, shoulder; subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61586","name":"Resect nasopharynx skull","description":"Bicoronal, transzygomatic and/or lefort i osteotomy approach to anterior cranial fossa with or without internal fixation, without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0575","name":"Nebulizer ultrasonic","description":"Nebulizer, ultrasonic, large volume","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33250","name":"Ablate heart dysrhythm focus","description":"Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, wolff-parkinson-white, atrioventricular node re-entry), tract(s) and/or focus (foci); without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1261.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31020","name":"Exploration maxillary sinus","description":"Sinusotomy, maxillary (antrotomy); intranasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73525","name":"Contrast x-ray of hip","description":"Radiologic examination, hip, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85362","name":"Fibrin degradation products","description":"Fibrin(ogen) degradation (split) products (fdp) (fsp); agglutination slide, semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67036","name":"Removal of inner eye fluid","description":"Vitrectomy, mechanical, pars plana approach;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":539.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77327","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62273","name":"Inject epidural patch","description":"Injection, epidural, of blood or clot patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26742","name":"Treat finger fracture each","description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62284","name":"Injection for myelogram","description":"Injection procedure for myelography and/or computed tomography, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63655","name":"Implant neuroelectrodes","description":"Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65220","name":"Remove foreign body from eye","description":"Removal of foreign body, external eye; corneal, without slit lamp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50686","name":"Measure ureter pressure","description":"Manometric studies through ureterostomy or indwelling ureteral catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36410","name":"Vnpnxr 3yr/> phy/qhp dx/ther","description":"Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27840","name":"Treat ankle dislocation","description":"Closed treatment of ankle dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48145","name":"Partial removal of pancreas","description":"Pancreatectomy, distal subtotal, with or without splenectomy; with pancreaticojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88184","name":"Flowcytometry/ tc 1 marker","description":"Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90862","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39503","name":"Repair of diaphragm hernia","description":"Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5326.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9187","name":"Bpci home visit","description":"Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/managemen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6950","name":"Above elbow switch control","description":"Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00322","name":"Anes all px nck ndl bx thyr","description":"Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; needle biopsy of thyroid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91132","name":"Electrogastrography","description":"Electrogastrography, diagnostic, transcutaneous;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27033","name":"Arthrt hip expl/rmv loose/fb","description":"Arthrotomy, hip, including exploration or removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":823.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90912","name":"Bfb training 1st 15 min","description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including emg and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93642","name":"Ep evl 1/2chmb trnsvns cvdfb","description":"Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96913","name":"Photochemotx sev dermatoses","description":"Photochemotherapy (goeckerman and/or puva) for severe photoresponsive dermatoses requiring at least 4-8 hours of care under direct supervision of the physician (includes application of medication and dressings)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58200","name":"Extensive hysterectomy","description":"Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":863.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86308","name":"Heterophile antibody screen","description":"Heterophile antibodies; screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25405","name":"Repair/graft radius or ulna","description":"Repair of nonunion or malunion, radius or ulna; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51045","name":"Incise bladder/drain ureter","description":"Cystotomy, with insertion of ureteral catheter or stent (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":416.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50436","name":"Dilat xst trc ndurlgc px","description":"Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83528","name":"Assay of intrinsic factor","description":"Intrinsic factor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93010","name":"Electrocardiogram report","description":"Electrocardiogram, routine ecg with at least 12 leads; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70190","name":"X-ray exam of eye sockets","description":"Radiologic examination; optic foramina","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50021","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":786.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50725","name":"Release/revise ureter","description":"Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":892.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87809","name":"Adenovirus assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; adenovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95831","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78104","name":"Bone marrow imaging body","description":"Bone marrow imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75958","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":445.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50706","name":"Balloon dilate urtrl strix","description":"Balloon dilation, ureteral stricture, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":762.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6537","name":"Gc stocking full lngth 30-40","description":"Gradient compression stocking, full length/chap style, 30-40 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50785","name":"Reimplant ureter in bladder","description":"Ureteroneocystostomy; with vesico-psoas hitch or bladder flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":986.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11644","name":"Exc f/e/e/n/l mal+mrg 3.1-4","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58956","name":"Bso omentectomy w/tah","description":"Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45130","name":"Excision of rectal prolapse","description":"Excision of rectal procidentia, with anastomosis; perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2023","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88275","name":"Cytogenetics 100-300","description":"Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99335","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20970","name":"Bone/skin graft iliac crest","description":"Free osteocutaneous flap with microvascular anastomosis; iliac crest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21138","name":"Rdctj forehead cntrg&prostc","description":"Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1020","name":"Residual limb support system","description":"Residual limb support system for wheelchair, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4358","name":"Urinary leg or abdomen bag","description":"Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25605","name":"Cltx dst rdl fx/ephys sep w/","description":"Closed treatment of distal radial fracture (eg, colles or smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50572","name":"Kidney endoscopy","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26356","name":"Repair finger/hand tendon","description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no mans land); primary, without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":661.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27437","name":"Revise kneecap","description":"Arthroplasty, patella; without prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":555.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2323","name":"Special joystick handle","description":"Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75791","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":257.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0042T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41140","name":"Removal of tongue","description":"Glossectomy; complete or total, with or without tracheostomy, without radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1691.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69552","name":"Exc aurl glomus tum trnsmstd","description":"Excision aural glomus tumor; transmastoid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27442","name":"Revision of knee joint","description":"Arthroplasty, femoral condyles or tibial plateau(s), knee;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57296","name":"Revise vag graft open abd","description":"Revision (including removal) of prosthetic vaginal graft; open abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15944","name":"Exc isch pr ulc skn flp clsr","description":"Excision, ischial pressure ulcer, with skin flap closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":588.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0427","name":"Inpt/ed teleconsult70","description":"Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78815","name":"Pet image w/ct skull-thigh","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; skull base to mid-thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22585","name":"Arthrd ant ntrbd min dsc ea","description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0197","name":"Air pressure pad for mattres","description":"Air pressure pad for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27442","name":"Revision of knee joint","description":"Arthroplasty, femoral condyles or tibial plateau(s), knee;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":737.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78832","name":"Rp loclzj tum spect w/ct 2","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect) with concurrently acquired computed tomography (ct) transmission scan for anatomical review, localizati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":750.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4312","name":"Cath w/o bag 2-way silicone","description":"Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83864","name":"Mucopolysaccharides","description":"Mucopolysaccharides, acid, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0731","name":"Conductive garment for tens/","description":"Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patients skin by layers of fabric)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85301","name":"Antithrombin iii antigen","description":"Clotting inhibitors or anticoagulants; antithrombin iii, antigen assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0744","name":"Neuromuscular stim for scoli","description":"Neuromuscular stimulator for scoliosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4417","name":"Ost pch w bar/bltinconv/fltr","description":"Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54600","name":"Reduce testis torsion","description":"Reduction of torsion of testis, surgical, with or without fixation of contralateral testis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":366.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8512","name":"Gel cap for trach voice pros","description":"Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95710","name":"Eeg w/o vid ea 12-26hr cont","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64617","name":"Chemodener muscle larynx emg","description":"Chemodenervation of muscle(s); larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93245","name":"Ext ecg>7d<15d rec scan a/r","description":"External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":271.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46940","name":"Treatment of anal fissure","description":"Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":191.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7509","name":"Heat & moisture exchange sys","description":"Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69535","name":"Remove part of temporal bone","description":"Resection temporal bone, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2141.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2523","name":"Cntct lens hydrophil extend","description":"Contact lens, hydrophilic, extended wear, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35121","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, hepatic, celiac, renal, or mesenteric artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1397.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27758","name":"Treatment of tibia fracture","description":"Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":755.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0959","name":"Amputee adapter","description":"Manual wheelchair accessory, adapter for amputee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51726","name":"Complex cystometrogram","description":"Complex cystometrogram (ie, calibrated electronic equipment);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93316","name":"Echo transesophageal","description":"Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0442","name":"Stationary o2 contents, liq","description":"Stationary oxygen contents, liquid, 1 months supply = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9143","name":"Warfarin respon genetic test","description":"Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95852","name":"Range of motion measurements","description":"Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29715","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1238","name":"Fld ped wc adjstabl w/o seat","description":"Wheelchair, pediatric size, folding, adjustable, without seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82308","name":"Assay of calcitonin","description":"Calcitonin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61705","name":"Revise circulation to head","description":"Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial and cervical occlusion of carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87400","name":"Influenza a/b each ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; influenza, a or b, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0085","name":"Care man h v ext pt 75 m","description":"Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58662","name":"Laparoscopy excise lesions","description":"Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":457.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80173","name":"Assay of haloperidol","description":"Haloperidol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33210","name":"Insert electrd/pm cath sngl","description":"Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86821","name":"Lymphocyte culture mixed","description":"Hla typing; lymphocyte culture, mixed (mlc)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88368","name":"Insitu hybridization manual","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2366","name":"Battery charger, single mode","description":"Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11446","name":"Exc face-mm b9+marg >4 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26415","name":"Excision hand/finger tendon","description":"Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":691.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33991","name":"Insj perq vad l hrt artl&ven","description":"Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21325","name":"Open tx nose fx uncomplicatd","description":"Open treatment of nasal fracture; uncomplicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9278","name":"External receiver, cgm sys","description":"Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0073","name":"Caster pin lock each","description":"Caster pin lock, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78454","name":"Ht musc image planar mult","description":"Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36598","name":"Inj w/fluor eval cv device","description":"Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43272","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":329.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48540","name":"Fuse pancreas cyst and bowel","description":"Internal anastomosis of pancreatic cyst to gastrointestinal tract; roux-en-y","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1099.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77002","name":"Needle localization by xray","description":"Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20974","name":"Estim aid bone healg n-invas","description":"Electrical stimulation to aid bone healing; noninvasive (nonoperative)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93624","name":"Ep f-up study pacg&rec","description":"Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00932","name":"Anes male gent compl amp pns","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); complete amputation of penis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P3001","name":"Screening pap smear by phys","description":"Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32651","name":"Thoracoscopy remove cortex","description":"Thoracoscopy, surgical; with partial pulmonary decortication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33419","name":"Repair tcat mitral valve","description":"Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":367.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44379","name":"S bowel endoscope w/stent","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with transendoscopic stent placement (includes predilation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76826","name":"Echo exam of fetal heart","description":"Echocardiography, fetal, cardiovascular system, real time with image documentation (2d), with or without m-mode recording; follow-up or repeat study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20665","name":"Rmvl tongs/halo anthr indiv","description":"Removal of tongs or halo applied by another individual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96138","name":"Psycl/nrpsyc tech 1st","description":"Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34820","name":"Opn iliac art expos","description":"Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35558","name":"Art byp grft fem-femoral","description":"Bypass graft, with vein; femoral-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87338","name":"Hpylori stool ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; helicobacter pylori, stool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5666","name":"Below knee cuff suspension","description":"Addition to lower extremity, below knee, cuff suspension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2230","name":"Split flat caliper stirr & p","description":"Addition to lower extremity, split flat caliper stirrups and plate attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2380","name":"Torsion straight knee joint","description":"Addition to lower extremity, torsion control, straight knee joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97130","name":"Ther ivntj ea addl 15 min","description":"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26440","name":"Release palm/finger tendon","description":"Tenolysis, flexor tendon; palm or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":518.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86648","name":"Diphtheria antibody","description":"Antibody; diphtheria","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30620","name":"Intranasal reconstruction","description":"Septal or other intranasal dermatoplasty (does not include obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2308","name":"Lens sphc trifocal 4.25-7/2.","description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00866","name":"Anes xtrprt lw abd adrnlctmy","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; adrenalectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86359","name":"T cells total count","description":"T cells; total count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0948","name":"Fracture frame attachmnts ce","description":"Fracture frame, attachments for complex cervical traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52640","name":"Relieve bladder contracture","description":"Transurethral resection; of postoperative bladder neck contracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":255.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27614","name":"Biopsy lower leg soft tissue","description":"Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":476.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50688","name":"Change of ureter tube/stent","description":"Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71046","name":"X-ray exam chest 2 views","description":"Radiologic examination, chest; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55866","name":"Laps surg prst8ect rpbic rad","description":"Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1168.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0604","name":"Repl batt lithium 3.6 v","description":"Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23150","name":"Removal of humerus lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal humerus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77300","name":"Radiation therapy dose plan","description":"Basic radiation dosimetry calculation, central axis depth dose calculation, tdf, nsd, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82163","name":"Assay of angiotensin ii","description":"Angiotensin ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33206","name":"Insert heart pm atrial","description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6713","name":"Ped term dev, hand, vol open","description":"Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":761.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A4365","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13153","name":"Cmplx rpr e/n/e/l addl 5cm/<","description":"Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4070","name":"Replace prox & dist upright","description":"Replace proximal and distal upright for kafo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6646","name":"Multipo locking shoulder jnt","description":"Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1536.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34805","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1015.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36818","name":"Av fuse uppr arm cephalic","description":"Arteriovenous anastomosis, open; by upper arm cephalic vein transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24332","name":"Tenolysis triceps","description":"Tenolysis, triceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":516.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72133","name":"Ct lumbar spine w/o & w/dye","description":"Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69711","name":"Remove/repair hearing aid","description":"Removal or repair of electromagnetic bone conduction hearing device in temporal bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2182","name":"Drop lock knee","description":"Addition to lower extremity fracture orthosis, drop lock knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85293","name":"Clot factor wght kininogen","description":"Clotting; high molecular weight kininogen assay (fitzgerald factor assay)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35045","name":"Repair defect of arm artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, radial or ulnar artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28102","name":"Remove/graft foot lesion","description":"Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":512.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4500","name":"Below knee surgical stocking","description":"Surgical stockings below knee length, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50391","name":"Instll rx agnt into rnal tub","description":"Instillation(s) of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53060","name":"Drainage of urethra abscess","description":"Drainage of skenes gland abscess or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96112","name":"Devel tst phys/qhp 1st hr","description":"Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0420T","name":"Dstrj neurofibroma xtnsv","description":"Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 neurofibromas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35647","name":"Bpg aortofemoral","description":"Bypass graft, with other than vein; aortofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93565","name":"Njx car cth slctv lv/la ang","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective left ventricular or left atrial angiography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53000","name":"Incision of urethra","description":"Urethrotomy or urethrostomy, external (separate procedure); pendulous urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94619","name":"Exercise tst brncspsm wo ecg","description":"Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; without electrocardiographic recording(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25335","name":"Centralization wrist on ulna","description":"Centralization of wrist on ulna (eg, radial club hand)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35516","name":"Art byp grft subclav-axilary","description":"Bypass graft, with vein; subclavian-axillary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1077.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78496","name":"Heart first pass add-on","description":"Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72190","name":"X-ray exam of pelvis","description":"Radiologic examination, pelvis; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62362","name":"Implant spine infusion pump","description":"Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30420","name":"Reconstruction of nose","description":"Rhinoplasty, primary; including major septal repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87278","name":"Legion pneumophilia ag if","description":"Infectious agent antigen detection by immunofluorescent technique; legionella pneumophila","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33548","name":"Restore/remodel ventricle","description":"Surgical ventricular restoration procedure, includes prosthetic patch, when performed (eg, ventricular remodeling, svr, saver, dor procedures)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19298","name":"Place breast rad tube/caths","description":"Placement of radiotherapy after loading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":623.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8435","name":"Pros sock multi ply upper lm","description":"Prosthetic sock, multiple ply, upper limb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91035","name":"G-esoph reflx tst w/electrod","description":"Esophagus, gastroesophageal reflux test; with mucosal attached telemetry ph electrode placement, recording, analysis and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00640","name":"Anes spine manipulation","description":"Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7401","name":"Add ue prost a/e ultlite mat","description":"Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01140","name":"Anes ntrplvabdmnl amputation","description":"Anesthesia for interpelviabdominal (hindquarter) amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33952","name":"Ecmo/ecls insj prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2504","name":"Sgd prerec msg>20min <=40min","description":"Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2768","name":"Ortho sidebar disconnect","description":"Orthotic side bar disconnect device, per bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46900","name":"Destruction anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77307","name":"Telethx isodose plan cplx","description":"Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0843","name":"Pwc gp2 hd mult pow opt s/b","description":"Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67923","name":"Repair eyelid defect","description":"Repair of entropion; excision tarsal wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82495","name":"Assay of chromium","description":"Chromium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64727","name":"Internal neurolysis","description":"Internal neurolysis, requiring use of operating microscope (list separately in addition to code for neuroplasty) (neuroplasty includes external neurolysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75989","name":"Abscess drainage under x-ray","description":"Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11102","name":"Tangntl bx skin single les","description":"Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77085","name":"Dxa bone density axl vrt fx","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94621","name":"Cardiopulm exercise testing","description":"Cardiopulmonary exercise testing, including measurements of minute ventilation, co2 production, o2 uptake, and electrocardiographic recordings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0474T","name":"Insj aqueous drg dev io rsvr","description":"Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44389","name":"Colonoscopy with biopsy","description":"Colonoscopy through stoma; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90849","name":"Multiple family group psytx","description":"Multiple-family group psychotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82239","name":"Bile acids total","description":"Bile acids; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99316","name":"Nf dschrg mgmt 30 min+","description":"Nursing facility discharge management; more than 30 minutes total time on the date of the encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33675","name":"Close mult vsd","description":"Closure of multiple ventricular septal defects;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1715.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6015","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85612","name":"Viper venom prothrombin time","description":"Russell viper venom time (includes venom); undiluted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19125","name":"Excision breast lesion","description":"Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70450","name":"Ct head/brain w/o dye","description":"Computed tomography, head or brain; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50706","name":"Balloon dilate urtrl strix","description":"Balloon dilation, ureteral stricture, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77003","name":"Fluoroguide for spine inject","description":"Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37617","name":"Ligation major artery abd","description":"Ligation, major artery (eg, post-traumatic, rupture); abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1151.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7012","name":"Nebulizer water collec devic","description":"Water collection device, used with large volume nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33227","name":"Remove&replace pm gen singl","description":"Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26535","name":"Revise finger joint","description":"Arthroplasty, interphalangeal joint; each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":359.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8616","name":"Coch implant microphone repl","description":"Microphone for use with cochlear implant device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6247","name":"Hydrogel drg > 48 sq in w/b","description":"Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63056","name":"Decompress spinal cord lmbr","description":"Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1324.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86941","name":"Hemolysins/agglutinins","description":"Hemolysins and agglutinins; incubated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29345","name":"Application of long leg cast","description":"Application of long leg cast (thigh to toes);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5460","name":"Postop app non-wgt bear dsg","description":"Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95924","name":"Ans parasymp & symp w/tilt","description":"Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33243","name":"Remove eltrd/thoracotomy","description":"Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84235","name":"Assay of endocrine hormone","description":"Receptor assay; endocrine, other than estrogen or progesterone (specify hormone)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3720","name":"Forearm/arm cuffs free motio","description":"Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43263","name":"Ercp sphincter pressure meas","description":"Endoscopic retrograde cholangiopancreatography (ercp); with pressure measurement of sphincter of oddi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74360","name":"X-ray guide gi dilation","description":"Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3221","name":"Orthopedic mens shoes dpth i","description":"Orthopedic footwear, mens shoe, depth inlay, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86891","name":"Autologous blood op salvage","description":"Autologous blood or component, collection processing and storage; intra- or postoperative salvage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0692","name":"Uvl sys panel 4 ft","description":"Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29846","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":436.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5704","name":"Custom shape cover bk","description":"Custom shaped protective cover, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35363","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; combined aortoiliofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1436.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0023","name":"Pin service 60m per month","description":"Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities:  person-centered assessment, performed to better understand the indiv","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33548","name":"Restore/remodel ventricle","description":"Surgical ventricular restoration procedure, includes prosthetic patch, when performed (eg, ventricular remodeling, svr, saver, dor procedures)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2578.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93461","name":"R&l hrt art/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, cath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27202","name":"Treat tail bone fracture","description":"Open treatment of coccygeal fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":447.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2302","name":"Lens sphere trifocal 7.12-20","description":"Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92576","name":"Synthetic sentence id test","description":"Synthetic sentence identification test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95832","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0623","name":"Sio rig pnl pelv/sac pre ots","description":"Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99220","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91022","name":"Duodenal motility study","description":"Duodenal motility (manometric) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23073","name":"Exc shoulder tum deep 5 cm/>","description":"Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77469","name":"Io radiation tx management","description":"Intraoperative radiation treatment management","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4149","name":"Ef blenderized foods","description":"Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0172","name":"Cerv col sr foam 2pc pre ots","description":"Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1836","name":"Ko rigid w/o joints pre ots","description":"Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82436","name":"Assay of urine chloride","description":"Chloride; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2227","name":"Gear reduction drive wheel","description":"Manual wheelchair accessory, gear reduction drive wheel, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21387","name":"Opn tx orbit fx combined","description":"Open treatment of orbital floor blowout fracture; combined approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0492","name":"Tlso 3 piece rigid shell","description":"Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21031","name":"Remove exostosis mandible","description":"Excision of torus mandibularis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1230","name":"Power operated vehicle","description":"Power operated vehicle (three or four wheel nonhighway) specify brand name and model number","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90867","name":"Tcranial magn stim tx plan","description":"Therapeutic repetitive transcranial magnetic stimulation (tms) treatment; initial, including cortical mapping, motor threshold determination, delivery and management","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":367.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77332","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; simple (simple block, simple bolus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31512","name":"Removal of larynx lesion","description":"Laryngoscopy, indirect; with removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6455","name":"Self-adher band >=5in/yd","description":"Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66165","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":424.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87901","name":"Nfct agt gntyp alys hiv1 rev","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); hiv-1, reverse transcriptase and protease regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92526","name":"Oral function therapy","description":"Treatment of swallowing dysfunction and/or oral function for feeding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6882","name":"Microprocessor control uplmb","description":"Microprocessor control feature, addition to upper limb prosthetic terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76936","name":"Echo guide for artery repair","description":"Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99082","name":"Unusual physician travel","description":"Unusual travel (eg, transportation and escort of patient)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61154","name":"Burr hole w/evac&/drg hmtma","description":"Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14040","name":"Tis trnfr f/c/c/m/n/a/g/h/f","description":"Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96372","name":"Ther/proph/diag inj sc/im","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65400","name":"Removal of eye lesion","description":"Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0512T","name":"Esw integ wnd hlg 1st wnd","description":"Extracorporeal shock wave for integumentary wound healing, including topical application and dressing care; initial wound","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4495","name":"Thigh length surg stocking","description":"Surgical stockings thigh length, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43520","name":"Incision of pyloric muscle","description":"Pyloromyotomy, cutting of pyloric muscle (fredet-ramstedt type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33335","name":"Insert major vessel graft","description":"Insertion of graft, aorta or great vessels; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1623.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81173","name":"Ar gene full gene sequence","description":"Ar (androgen receptor) (eg, spinal and bulbar muscular atrophy, kennedy disease, x chromosome inactivation) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8430","name":"Prosthetic sock multi ply ak","description":"Prosthetic sock, multiple ply, above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32651","name":"Thoracoscopy remove cortex","description":"Thoracoscopy, surgical; with partial pulmonary decortication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":874.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25023","name":"Decompress forearm 1 space","description":"Decompression fasciotomy, forearm and/or wrist, flexor or extensor compartment; with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64408","name":"Njx aa&/strd vagus nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; vagus nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49605","name":"Repair umbilical lesion","description":"Repair of large omphalocele or gastroschisis; with or without prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4188.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95939","name":"C motor evoked upr&lwr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0150","name":"Cerv semi-rig adj molded chn","description":"Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66991","name":"Xcapsl ctrc rmvl insj 1+","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drai","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":399.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80417","name":"Renin stimulation panel","description":"Peripheral vein renin stimulation panel (eg, captopril) this panel must include the following: renin (84244 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19000","name":"Puncture aspir cyst breast","description":"Puncture aspiration of cyst of breast;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0217","name":"Water circ heat pad w pump","description":"Water circulating heat pad with pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0730","name":"Ctrl dose inh drug deliv sys","description":"Controlled dose inhalation drug delivery system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82127","name":"Amino acid single qual","description":"Amino acids; single, qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92549","name":"Cdp-sot 6 cond w/i&r mct&adt","description":"Computerized dynamic posturography sensory organization test (cdp-sot), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (mct) and adaptation test (adt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63082","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A8000","name":"Soft protect helmet prefab","description":"Helmet, protective, soft, prefabricated, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51800","name":"Revision of bladder/urethra","description":"Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck (anterior y-plasty, vesical fundus resection), any procedure, with or without wedge resection of posterior vesical neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":846.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82615","name":"Test for urine cystines","description":"Cystine and homocystine, urine, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95710","name":"Eeg w/o vid ea 12-26hr cont","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22102","name":"Remove part lumbar vertebra","description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":702.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26706","name":"Pin knuckle dislocation","description":"Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5051","name":"Pouch clsd w barr attached","description":"Ostomy pouch, closed; with barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60505","name":"Explore parathyroid glands","description":"Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27450","name":"Incision of thigh","description":"Osteotomy, femur, shaft or supracondylar; with fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27882","name":"Amputation of lower leg","description":"Amputation, leg, through tibia and fibula; open, circular (guillotine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61315","name":"Crnec/crnot ittl ntracereblr","description":"Craniectomy or craniotomy for evacuation of hematoma, infratentorial; intracerebellar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1890.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86256","name":"Fluorescent antibody titer","description":"Fluorescent noninfectious agent antibody; titer, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92230","name":"Fluorescein angioscopy i&r","description":"Fluorescein angioscopy with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26590","name":"Repair finger deformity","description":"Repair macrodactylia, each digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A6201","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77047","name":"Mri breast c- bilateral","description":"Magnetic resonance imaging, breast, without contrast material; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85013","name":"Spun microhematocrit","description":"Blood count; spun microhematocrit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33468","name":"Revision of tricuspid valve","description":"Tricuspid valve repositioning and plication for ebstein anomaly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5614","name":"4-bar link above knee w/swng","description":"Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":822.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57800","name":"Dilation of cervical canal","description":"Dilation of cervical canal, instrumental (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20700","name":"Mnl prep&insj dp rx dlvr dev","description":"Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0272","name":"Mattress foam rubber","description":"Mattress, foam rubber","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54800","name":"Biopsy of epididymis","description":"Biopsy of epididymis, needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28285","name":"Repair of hammertoe","description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":434.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72159","name":"Mr angio spine w/o&w/dye","description":"Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83945","name":"Assay of oxalate","description":"Oxalate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11643","name":"Exc f/e/e/n/l mal+mrg 2.1-3","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77290","name":"Ther rad simulaj field cplx","description":"Therapeutic radiology simulation-aided field setting; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38220","name":"Dx bone marrow aspirations","description":"Diagnostic bone marrow; aspiration(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3649","name":"Orthopedic shoe modifica nos","description":"Orthopedic shoe, modification, addition or transfer, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68325","name":"Revise/graft eyelid lining","description":"Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0130","name":"Flex thermoplastic collar mo","description":"Cervical, flexible, thermoplastic collar, molded to patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93622","name":"Comp ep eval l ventr pac&rec","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0261","name":"Hosp bed semi-electr w/o mat","description":"Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35276","name":"Rpr blvs gr ot/t vn ntrth wo","description":"Repair blood vessel with graft other than vein; intrathoracic, without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2360","name":"Extended steel shank","description":"Addition to lower extremity, extended steel shank","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63273","name":"Excise intrspinl lesion scrl","description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80157","name":"Assay carbamazepine free","description":"Carbamazepine; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99175","name":"Induction of vomiting","description":"Ipecac or similar administration for individual emesis and continued observation until stomach adequately emptied of poison","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26060","name":"Incision of finger tendon","description":"Tenotomy, percutaneous, single, each digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0825","name":"Pwc gp 2 hd cap chair","description":"Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0202U","name":"Nfct ds 22 trgt sars-cov-2","description":"Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (dna or rna), 22 targets including severe acute respiratory syndrome coronavirus 2 (sars-cov-2), qualitative rt-pcr, nasopharyngeal swab, each pathogen reported as detected or not detected","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95965","name":"Meg spontaneous","description":"Magnetoencephalography (meg), recording and analysis; for spontaneous brain magnetic activity (eg, epileptic cerebral cortex localization)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1816.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0196","name":"Gel pressure mattress","description":"Gel pressure mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25441","name":"Arthrp w/prostc dstl rds","description":"Arthroplasty with prosthetic replacement; distal radius","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":792.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38780","name":"Remove abdomen lymph nodes","description":"Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":664.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40700","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01916","name":"Anes dx arteriography/vngrph","description":"Anesthesia for diagnostic arteriography/venography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33647","name":"Repair heart septum defects","description":"Repair of atrial septal defect and ventricular septal defect, with direct or patch closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6250","name":"Elbow inter loc elbow forarm","description":"Above elbow, molded double wall socket, internal locking elbow, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1404.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1910","name":"Afo sing bar clasp attach sh","description":"Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0365","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15835","name":"Exc excessive skin buttock","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":601.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8624","name":"Lith ion batt cid, ear level","description":"Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38232","name":"Bone marrow harvest autolog","description":"Bone marrow harvesting for transplantation; autologous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27331","name":"Explore/treat knee joint","description":"Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49582","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":401.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84460","name":"Alanine amino (alt) (sgpt)","description":"Transferase; alanine amino (alt) (sgpt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3763","name":"Ewho rigid w/o jnts cf","description":"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":341.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34832","name":"Open aortofemor prosth repr","description":"Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1676.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29044","name":"Appl bdy cst sho to hip 1thi","description":"Application of body cast, shoulder to hips; including 1 thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72100","name":"X-ray exam l-s spine 2/3 vws","description":"Radiologic examination, spine, lumbosacral; 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6350","name":"Thoracic intern lock elbow","description":"Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72192","name":"Ct pelvis w/o dye","description":"Computed tomography, pelvis; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23800","name":"Arthrodesis glenohumeral jt","description":"Arthrodesis, glenohumeral joint;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86704","name":"Hep b core antibody total","description":"Hepatitis b core antibody (hbcab); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9503","name":"Tc99m medronate","description":"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54316","name":"Reconstruction of urethra","description":"Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft obtained from site other than genitalia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86769","name":"Sars-cov-2 covid-19 antibody","description":"Antibody; severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3900","name":"Hinge extension/flex wrist/f","description":"Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25025","name":"Decompress forearm 2 spaces","description":"Decompression fasciotomy, forearm and/or wrist, flexor and extensor compartment; with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93304","name":"Echo transthoracic","description":"Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97014","name":"Electric stimulation therapy","description":"Application of a modality to 1 or more areas; electrical stimulation (unattended)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5131","name":"Appliance cleaner","description":"Appliance cleaner, incontinence and ostomy appliances, per 16 oz.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88125","name":"Forensic cytopathology","description":"Cytopathology, forensic (eg, sperm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20957","name":"Mt bone graft microvasc","description":"Bone graft with microvascular anastomosis; metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2367","name":"Battery charger, dual mode","description":"Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0146T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93290","name":"Interrog dev eval icpms ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of 1 or more reco","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0024","name":"Pin srv add 30 min pr m","description":"Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58554","name":"Laparo-vag hyst w/t/o compl","description":"Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72194","name":"Ct pelvis w/o & w/dye","description":"Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35508","name":"Art byp grft carotid-vertbrl","description":"Bypass graft, with vein; carotid-vertebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1171.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21490","name":"Optx tmprmand dislocation","description":"Open treatment of temporomandibular dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85441","name":"Heinz bodies direct","description":"Heinz bodies; direct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9503","name":"Tc99m medronate","description":"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2342","name":"W/c dpth 20-21 in seat frame","description":"Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27392","name":"Incision of thigh tendons","description":"Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23105","name":"Arthrotomy glenohumeral jt","description":"Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":535.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29435","name":"Appl patllr tdn bearing cast","description":"Application of patellar tendon bearing (ptb) cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27625","name":"Remove ankle joint lining","description":"Arthrotomy, with synovectomy, ankle;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64451","name":"Njx aa&/strd nrv nrvtg si jt","description":"Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88311","name":"Decalcify tissue","description":"Decalcification procedure (list separately in addition to code for surgical pathology examination)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22840","name":"Insert spine fixation device","description":"Posterior non-segmental instrumentation (eg, harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at c1, facet screw fixation) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1815","name":"Adjust ankle ext & flex dev","description":"Dynamic adjustable ankle extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85305","name":"Clot inhibit prot s total","description":"Clotting inhibitors or anticoagulants; protein s, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73502","name":"X-ray exam hip uni 2-3 views","description":"Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96373","name":"Ther/proph/diag inj ia","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25390","name":"Shorten radius or ulna","description":"Osteoplasty, radius or ulna; shortening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87808","name":"Trichomonas assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; trichomonas vaginalis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1220","name":"Anterior thoracic extension","description":"Addition to tlso, (low profile), anterior thoracic extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48554","name":"Transpl allograft pancreas","description":"Transplantation of pancreatic allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22552","name":"Arthrd ant ntrbd cervical ea","description":"Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below c2, each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63278","name":"Bx/exc xdrl spine lesn scrl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24125","name":"Exc/crtg b1 cst/tum rds agrf","description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":523.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67108","name":"Repair detached retina","description":"Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":716.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2106","name":"Spherocylinder 4.00d/>6.00d","description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68420","name":"I&d lacrimal sac","description":"Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43757","name":"Dx duod intub w/asp specs","description":"Duodenal intubation and aspiration, diagnostic, includes image guidance; collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube, includes drug administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21151","name":"Rcnstj mdfc lefrtii w/b1 grf","description":"Reconstruction midface, lefort ii; any direction, requiring bone grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1479.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8680","name":"Implt neurostim elctr each","description":"Implantable neurostimulator electrode, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":224.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87277","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31641","name":"Bronchoscopy treat blockage","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision (eg, laser therapy, cryotherapy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23550","name":"Optx acromclv dislc aqt/chrn","description":"Open treatment of acromioclavicular dislocation, acute or chronic;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82820","name":"Hemoglobin-oxygen affinity","description":"Hemoglobin-oxygen affinity (po2 for 50% hemoglobin saturation with oxygen)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0276","name":"Bed pan fracture","description":"Bed pan, fracture, metal or plastic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56632","name":"Vlvctmy rad prtl bi lymphad","description":"Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11640","name":"Exc f/e/e/n/l mal+mrg 0.5cm<","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11041","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0475","name":"Hiv combination assay","description":"Hiv antigen/antibody, combination assay, screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32605","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":302.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56631","name":"Vlvctmy rad prtl uni lymphad","description":"Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33221","name":"Insert pulse gen mult leads","description":"Insertion of pacemaker pulse generator only; with existing multiple leads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69960","name":"Release inner ear canal","description":"Decompression internal auditory canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1540.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82649","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43214","name":"Esophagosc dilate balloon 30","description":"Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00812","name":"Anes lwr intst scr colsc","description":"Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20225","name":"Bone biopsy trocar/ndl deep","description":"Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33474","name":"Revision of pulmonary valve","description":"Valvotomy, pulmonary valve, open heart, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1894.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55706","name":"Bx prst8 ndl sat sampling","description":"Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44960","name":"Appendectomy","description":"Appendectomy; for ruptured appendix with abscess or generalized peritonitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":732.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44392","name":"Colonoscopy & polypectomy","description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77778","name":"Apply interstit radiat compl","description":"Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27438","name":"Revise kneecap with implant","description":"Arthroplasty, patella; with prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64862","name":"Repair of low back nerves","description":"Suture of; lumbar plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1167.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28630","name":"Treat toe dislocation","description":"Closed treatment of metatarsophalangeal joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68371","name":"Harvest eye tissue alograft","description":"Harvesting conjunctival allograft, living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36680","name":"Insert needle bone cavity","description":"Placement of needle for intraosseous infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97035","name":"App mdlty 1+ultrasound ea 15","description":"Application of a modality to 1 or more areas; ultrasound, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21337","name":"Closed tx septal&nose fx","description":"Closed treatment of nasal septal fracture, with or without stabilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":333.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33270","name":"Ins/rep subq defibrillator","description":"Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic param","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21260","name":"Revise eye sockets","description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28635","name":"Treat toe dislocation","description":"Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29894","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78469","name":"Heart infarct image (3d)","description":"Myocardial imaging, infarct avid, planar; tomographic spect with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26010","name":"Drainage of finger abscess","description":"Drainage of finger abscess; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9500","name":"Tc99m sestamibi","description":"Technetium tc-99m sestamibi, diagnostic, per study dose","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20933","name":"Hemicrt intrclry algrft prtl","description":"Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70332","name":"X-ray exam of jaw joint","description":"Temporomandibular joint arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00625","name":"Anes thrc spine wo 1lng vent","description":"Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; not utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87320","name":"Chlmyd trach ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; chlamydia trachomatis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21255","name":"Reconstruct lower jaw bone","description":"Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87071","name":"Culture aerobic quant other","description":"Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92549","name":"Cdp-sot 6 cond w/i&r mct&adt","description":"Computerized dynamic posturography sensory organization test (cdp-sot), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (mct) and adaptation test (adt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83986","name":"Assay ph body fluid nos","description":"Ph; body fluid, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95824","name":"Eeg cerebral death only","description":"Electroencephalogram (eeg); cerebral death evaluation only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31605","name":"Emer tracheostomy cthyr mem","description":"Tracheostomy, emergency procedure; cricothyroid membrane","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44207","name":"L colectomy/coloproctostomy","description":"Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35182","name":"Rpr cgen av fistula thrx&abd","description":"Repair, congenital arteriovenous fistula; thorax and abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83003","name":"Assay growth hormone (hgh)","description":"Growth hormone, human (hgh) (somatotropin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93314","name":"Echo transesophageal","description":"Echocardiography, transesophageal, real-time with image documentation (2d) (with or without m-mode recording); image acquisition, interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32150","name":"Removal of lung lesion(s)","description":"Thoracotomy; with removal of intrapleural foreign body or fibrin deposit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":797.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98970","name":"Nqhp ol dig assmt&mgmt 5-10","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76514","name":"Echo exam of eye thickness","description":"Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64792","name":"Removal of nerve lesion","description":"Excision of neurofibroma or neurolemmoma; extensive (including malignant type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":910.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63266","name":"Excise intrspinl lesion thrc","description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1558.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24359","name":"Repair elbow deb/attch open","description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfers elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":555.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57010","name":"Colpotomy drg pel abscess","description":"Colpotomy; with drainage of pelvic abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36468","name":"Njx sclrsnt spider veins","description":"Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54160","name":"Circumcision neonate","description":"Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6640","name":"Shoulder abduction joint pai","description":"Upper extremity additions, shoulder abduction joint, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1007","name":"Pwr seat combo w/shear","description":"Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84597","name":"Assay of vitamin k","description":"Vitamin k","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96367","name":"Tx/proph/dg addl seq iv inf","description":"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2213","name":"Initiat med assist tx in er","description":"Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97124","name":"Massage therapy","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44160","name":"Removal of colon","description":"Colectomy, partial, with removal of terminal ileum with ileocolostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1027.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28041","name":"Exc foot/toe tum dep 1.5cm/>","description":"Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); 1.5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":366.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25112","name":"Reremove wrist tendon lesion","description":"Excision of ganglion, wrist (dorsal or volar); recurrent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64831","name":"Repair of digit nerve","description":"Suture of digital nerve, hand or foot; 1 nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q4010","name":"Cast sup sht arm adult fbrgl","description":"Cast supplies, short arm cast, adult (11 years +), fiberglass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8040","name":"Nasal prosthesis","description":"Nasal prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","KM","95","93","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42107","name":"Excision lesion mouth roof","description":"Excision, lesion of palate, uvula; with local flap closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43198","name":"Esophagosc flex trnsn biopsy","description":"Esophagoscopy, flexible, transnasal; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0175","name":"Commode chair foot rest","description":"Foot rest, for use with commode chair, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69602","name":"Rev mstdc rslt mod rad mstdc","description":"Revision mastoidectomy; resulting in modified radical mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":878.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83825","name":"Assay of mercury","description":"Mercury, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82672","name":"Assay of estrogen","description":"Estrogens; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93602","name":"Intra-atrial recording","description":"Intra-atrial recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43257","name":"Egd w/thrml txmnt gerd","description":"Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62263","name":"Epidural lysis mult sessions","description":"Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 2 or more days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21422","name":"Optx palatal/max fracture","description":"Open treatment of palatal or maxillary fracture (lefort i type);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4612","name":"Battery cables","description":"Battery cables; replacement for patient-owned ventilator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0607","name":"Blood glucose monitor home","description":"Home blood glucose monitor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19369","name":"Brst rcnstj 2 pdcl tram flap","description":"Breast reconstruction; with bipedicled transverse rectus abdominis myocutaneous (tram) flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49060","name":"Drain open retroperi abscess","description":"Drainage of retroperitoneal abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":908.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33966","name":"Ecmo/ecls rmvl prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38542","name":"Explore deep node(s) neck","description":"Dissection, deep jugular node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":329.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19306","name":"Mast rad urban type","description":"Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (urban type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":809.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46700","name":"Repair of anal stricture","description":"Anoplasty, plastic operation for stricture; adult","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":520.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23532","name":"Optx strclv dslc aq/chrn grf","description":"Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":527.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31820","name":"Closure of windpipe lesion","description":"Surgical closure tracheostomy or fistula; without plastic repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0247","name":"Routine footcare pt w lops","description":"Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wou","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81164","name":"Brca1&2 gen ful dup/del alys","description":"Brca1 (brca1, dna repair associated), brca2 (brca2, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":292.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75860","name":"Vein x-ray neck","description":"Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44202","name":"Lap enterectomy","description":"Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1149.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00873","name":"Anes lithotrp esw wo wtr bth","description":"Anesthesia for lithotripsy, extracorporeal shock wave; without water bath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00520","name":"Anes closed chest px nos","description":"Anesthesia for closed chest procedures; (including bronchoscopy) not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25301","name":"Fusion of tendons at wrist","description":"Tenodesis at wrist; extensors of fingers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":538.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95719","name":"Eeg phys/qhp ea incr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of eeg recording, interpretation and report after each 24-hour period; w","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93562","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0960","name":"W/c shoulder harness/straps","description":"Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99239","name":"Hosp ip/obs dschrg mgmt >30","description":"Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44388","name":"Colonoscopy thru stoma spx","description":"Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","53"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69705","name":"Nps surg dilat eust tube uni","description":"Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2476.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45020","name":"Drainage of rectal abscess","description":"Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":464.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99170","name":"Anogenital exam child w imag","description":"Anogenital examination, magnified, in childhood for suspected trauma, including image recording when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75901","name":"Remove cva device obstruct","description":"Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25520","name":"Cltx rdl shft fx&dislc","description":"Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (galeazzi fracture/dislocation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78191","name":"Platelet survival study","description":"Platelet survival study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50715","name":"Release of ureter","description":"Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1002.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86738","name":"Mycoplasma antibody","description":"Antibody; mycoplasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73580","name":"Contrast x-ray of knee joint","description":"Radiologic examination, knee, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54230","name":"Njx corpora cavernosograpy","description":"Injection procedure for corpora cavernosography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86022","name":"Platelet antibodies","description":"Antibody identification; platelet antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65222","name":"Remove foreign body from eye","description":"Removal of foreign body, external eye; corneal, with slit lamp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27232","name":"Treat thigh fracture","description":"Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":635.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63704","name":"Repair of spinal herniation","description":"Repair of myelomeningocele; less than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15940","name":"Exc ischial pr ulc prim sutr","description":"Excision, ischial pressure ulcer, with primary suture;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0546T","name":"Rf spectrsc ntraop mrgn asmt","description":"Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92314","name":"C-lens fitg tech ou","description":"Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens, both eyes except for aphakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92567","name":"Tympanometry","description":"Tympanometry (impedance testing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94450","name":"Breathing response hypoxia","description":"Breathing response to hypoxia (hypoxia response curve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11056","name":"Parng/cutg b9 hyprkr les 2-4","description":"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33017","name":"Prcrd drg 6yr+ w/o cgen car","description":"Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; 6 years and older without congenital cardiac anomaly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4310","name":"Insert tray w/o bag/cath","description":"Insertion tray without drainage bag and without catheter (accessories only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82800","name":"Blood ph","description":"Gases, blood, ph only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95972","name":"Alys cplx sp/pn npgt w/prgrm","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87340","name":"Hepatitis b surface ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hepatitis b surface antigen (hbsag)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8100","name":"Spacer without mask","description":"Holding chamber or spacer for use with an inhaler or nebulizer; without mask","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1717","name":"Brachytx, non-str,hdr ir-192","description":"Brachytherapy source, non-stranded, high dose rate iridium-192, per source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58662","name":"Laparoscopy excise lesions","description":"Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78635","name":"Csf ventriculography","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5814","name":"Endo knee-shin hydral swg ph","description":"Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40702","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 of 2 stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":803.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53449","name":"Repair uro sphincter","description":"Repair of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":495.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81180","name":"Atxn3 gene detc abnor allele","description":"Atxn3 (ataxin 3) (eg, spinocerebellar ataxia, machado-joseph disease) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96003","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82232","name":"Assay of beta-2 protein","description":"Beta-2 microglobulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13121","name":"Cmplx rpr s/a/l 2.6-7.5 cm","description":"Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61150","name":"Bur hol/trph drg brn abs/cst","description":"Burr hole(s) or trephine; with drainage of brain abscess or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78601","name":"Brain image w/flow < 4 views","description":"Brain imaging, less than 4 static views; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2190","name":"Waist belt","description":"Addition to lower extremity fracture orthosis, waist belt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56740","name":"Exc bartholins gland/cyst","description":"Excision of bartholins gland or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92547","name":"Supplemental electrical test","description":"Use of vertical electrodes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63286","name":"Bx/exc idrl imed lesn thrc","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2373.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85280","name":"Clot factor xii hageman","description":"Clotting; factor xii (hageman)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37718","name":"Lig div&strpg short saph vn","description":"Ligation, division, and stripping, short saphenous vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0523T","name":"Ntrapx c ffr w/3d funcjl map","description":"Intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention (list separately in addition to code ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47535","name":"Conversion ext bil drg cath","description":"Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33468","name":"Revision of tricuspid valve","description":"Tricuspid valve repositioning and plication for ebstein anomaly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2136.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64517","name":"N block inj hypogas plxs","description":"Injection, anesthetic agent; superior hypogastric plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93018","name":"Cv stress test i&r only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74742","name":"X-ray fallopian tube","description":"Transcervical catheterization of fallopian tube, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43425","name":"Repair esophagus opening","description":"Closure of esophagostomy or fistula; transthoracic or transabdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35539","name":"Art byp grft aortofemoral","description":"Bypass graft, with vein; aortofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2108","name":"Spherocylinder 4.25d/2.12-4d","description":"Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78230","name":"Salivary gland imaging","description":"Salivary gland imaging;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23921","name":"Disarticulation sho sec clsr","description":"Disarticulation of shoulder; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":394.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4090","name":"Repl met band kafo-afo calf/","description":"Replace metal bands kafo-afo, calf or distal thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6233","name":"Hydrogel dressing >48 sq in","description":"Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99463","name":"Same day nb discharge","description":"Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34842","name":"Endovasc visc aorta 2 graft","description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6623","name":"Spring-ass rot wrst w/ latch","description":"Upper extremity addition, spring assisted rotational wrist unit with latch release","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36591","name":"Draw blood off venous device","description":"Collection of blood specimen from a completely implantable venous access device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7360","name":"Six volt bat otto bock/eq ea","description":"Six volt battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34848","name":"Visc & infraren abd 4+ prost","description":"Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78601","name":"Brain image w/flow < 4 views","description":"Brain imaging, less than 4 static views; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93533","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2112.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78430","name":"Myocrd img pet rst/strs w/ct","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0222","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":206.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0064","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00938","name":"Anes insj penile prosthesis","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); insertion of penile prosthesis (perineal approach)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33274","name":"Tcat insj/rpl perm ldls pm","description":"Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":419.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85576","name":"Blood platelet aggregation","description":"Platelet, aggregation (in vitro), each agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7015","name":"Aerosol mask used w nebulize","description":"Aerosol mask, used with dme nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0218T","name":"Njx paravert w/us lumb/sac","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; third and any additional level(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91065","name":"Breath hydrogen/methane test","description":"Breath hydrogen or methane test (eg, for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal gastrointestinal transit)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81333","name":"Tgfbi gene common variants","description":"Tgfbi (transforming growth factor beta-induced) (eg, corneal dystrophy) gene analysis, common variants (eg, r124h, r124c, r124l, r555w, r555q)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2212","name":"Prolong outpt/office vis","description":"Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or w","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72133","name":"Ct lumbar spine w/o & w/dye","description":"Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61552","name":"Release of skull seams","description":"Craniectomy for craniosynostosis; multiple cranial sutures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1350.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59350","name":"Repair of uterus","description":"Hysterorrhaphy of ruptured uterus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12055","name":"Intmd rpr face/mm 12.6-20 cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36625","name":"Insertion catheter artery","description":"Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); cutdown","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77077","name":"Joint survey single view","description":"Joint survey, single view, 2 or more joints (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73551","name":"X-ray exam of femur 1","description":"Radiologic examination, femur; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22854","name":"Insj biomechanical device","description":"Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5580","name":"Prep ak ischial thermo mold","description":"Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0489","name":"Pwr pck base combo vad, rep","description":"Power pack base for use with electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50220","name":"Remove kidney open","description":"Nephrectomy, including partial ureterectomy, any open approach including rib resection;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50543","name":"Laparo partial nephrectomy","description":"Laparoscopy, surgical; partial nephrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61536","name":"Removal of brain lesion","description":"Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2373.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33261","name":"Ablate heart dysrhythm focus","description":"Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1397.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50225","name":"Removal kidney open complex","description":"Nephrectomy, including partial ureterectomy, any open approach including rib resection; complicated because of previous surgery on same kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69511","name":"Extensive mastoid surgery","description":"Mastoidectomy; radical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":997.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1161","name":"Manual adult wc w tiltinspac","description":"Manual adult size wheelchair, includes tilt in space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28406","name":"Prq skel fix clcnl fx w/mnpj","description":"Percutaneous skeletal fixation of calcaneal fracture, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0117","name":"Glaucoma scrn hgh risk direc","description":"Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75805","name":"Lymph vessel x-ray trunk","description":"Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":252.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4087","name":"Gastro/jejuno tube, std","description":"Gastrostomy/jejunostomy tube, standard, any material, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94776","name":"Ped home apnea mntr dl&alys","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitoring, download of information, receipt of transmission(s) and analyses by computer only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0632","name":"Lso sag rigid frame cust","description":"Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22533","name":"Arthrd lat xtrcvtry tq lmbr","description":"Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4333","name":"Urinary cath anchor device","description":"Urinary catheter anchoring device, adhesive skin attachment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35180","name":"Rpr cgen av fistula head&nck","description":"Repair, congenital arteriovenous fistula; head and neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":761.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43276","name":"Ercp stent exchange w/dilate","description":"Endoscopic retrograde cholangiopancreatography (ercp); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47620","name":"Removal of gallbladder","description":"Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31360","name":"Removal of larynx","description":"Laryngectomy; total, without radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87205","name":"Smear gram stain","description":"Smear, primary source with interpretation; gram or giemsa stain for bacteria, fungi, or cell types","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54420","name":"Revision of penis","description":"Corpora cavernosa-saphenous vein shunt (priapism operation), unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4315","name":"Cath w/drainage 2-way silcne","description":"Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77767","name":"Hdr rdncl skn surf brachytx","description":"Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26320","name":"Removal of implant from hand","description":"Removal of implant from finger or hand","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24152","name":"Rad resection tum radial h/n","description":"Radical resection of tumor, radial head or neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1141.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17260","name":"Dstrj mal les t/a/l 0.5 cm/<","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25290","name":"Incise wrist/forearm tendon","description":"Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58822","name":"Drain ovary abscess percut","description":"Drainage of ovarian abscess; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6444","name":"Conform band n/s w>=5in/yd","description":"Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82977","name":"Assay of ggt","description":"Glutamyltransferase, gamma (ggt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31786","name":"Remove windpipe lesion","description":"Excision of tracheal tumor or carcinoma; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1152.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67015","name":"Release of eye fluid","description":"Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00802","name":"Anes px lwr abdl wal pannic","description":"Anesthesia for procedures on lower anterior abdominal wall; panniculectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01112","name":"Anes bone marrow aspir&/bx","description":"Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50065","name":"Nl sec surg operj calculus","description":"Nephrolithotomy; secondary surgical operation for calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85597","name":"Phospholipid pltlt neutraliz","description":"Phospholipid neutralization; platelet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1405","name":"O2/water vapor enrich w/heat","description":"Oxygen and water vapor enriching system with heated delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66990","name":"Ophthalmic endoscope add-on","description":"Use of ophthalmic endoscope (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52356","name":"Cysto/uretero w/lithotripsy","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, gibbons or double-j type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81163","name":"Brca1&2 gene full seq alys","description":"Brca1 (brca1, dna repair associated), brca2 (brca2, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84583","name":"Assay of urine urobilinogen","description":"Urobilinogen, urine; semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81320","name":"Plcg2 gene common variants","description":"Plcg2 (phospholipase c gamma 2) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, r665w, s707f, l845f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17004","name":"Destroy premal lesions 15/>","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49418","name":"Insert tun ip cath perc","description":"Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":922.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34051","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43641","name":"Vagotomy & pylorus repair","description":"Vagotomy including pyloroplasty, with or without gastrostomy; parietal cell (highly selective)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1008.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82013","name":"Acetylcholinesterase assay","description":"Acetylcholinesterase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37761","name":"Ligate leg veins open","description":"Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0403T","name":"Diabetes prev standard curr","description":"Preventive behavior change, intensive program of prevention of diabetes using a standardized diabetes prevention program curriculum, provided to individuals in a group setting, minimum 60 minutes, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8046","name":"Partial facial prosthesis","description":"Partial facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","KM","95","93","NU","","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20824","name":"Replantation thumb complete","description":"Replantation, thumb (includes carpometacarpal joint to mp joint), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1752.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27604","name":"Drain lower leg bursa","description":"Incision and drainage, leg or ankle; infected bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43240","name":"Egd w/transmural drain cyst","description":"Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":301.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88350","name":"Imfluor ea addl 1antb stn px","description":"Immunofluorescence, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92577","name":"Stenger test speech","description":"Stenger test, speech","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27700","name":"Revision of ankle joint","description":"Arthroplasty, ankle;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":501.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77059","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":426.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6445","name":"Conform band s w <3in/yd","description":"Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43287","name":"Esphg dstl 2/3 w/laps moblj","description":"Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle and upper mediastinal esophagus and thoracic e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2320","name":"Non-molded lacer","description":"Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77074","name":"Radex osseous survey lmtd","description":"Radiologic examination, osseous survey; limited (eg, for metastases)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58340","name":"Catheter for hysterography","description":"Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (sis) or hysterosalpingography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44661","name":"Repair bowel-bladder fistula","description":"Closure of enterovesical fistula; with intestine and/or bladder resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20250","name":"Biopsy vrt bdy open thoracic","description":"Biopsy, vertebral body, open; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":343.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73721","name":"Mri jnt of lwr extre w/o dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27468","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1137.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46262","name":"Remove in/ex hem grps w/fist","description":"Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4355","name":"Bladder irrigation tubing","description":"Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28304","name":"Incision of midfoot bones","description":"Osteotomy, tarsal bones, other than calcaneus or talus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28546","name":"Treat foot dislocation","description":"Percutaneous skeletal fixation of tarsal bone dislocation, other than talotarsal, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":481.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65091","name":"Revise eye","description":"Evisceration of ocular contents; without implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43112","name":"Esphg tot w/thrcm","description":"Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (ie, mckeown esophagectomy or tri-incisional esophagectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32654","name":"Thoracoscopy contrl bleeding","description":"Thoracoscopy, surgical; with control of traumatic hemorrhage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":914.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36593","name":"Declot vascular device","description":"Declotting by thrombolytic agent of implanted vascular access device or catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54560","name":"Exploration for testis","description":"Exploration for undescended testis with abdominal exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":555.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92572","name":"Staggered spondaic word test","description":"Staggered spondaic word test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93050","name":"Art pressure waveform analys","description":"Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity art","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64790","name":"Removal of nerve lesion","description":"Excision of neurofibroma or neurolemmoma; major peripheral nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":718.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79005","name":"Nuclear rx oral admin","description":"Radiopharmaceutical therapy, by oral administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95829","name":"Surgery electrocorticogram","description":"Electrocorticogram at surgery (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1267.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35905","name":"Excision graft thorax","description":"Excision of infected graft; thorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93454","name":"Coronary artery angio s&i","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29827","name":"Sho arthrs srg rt8tr cuf rpr","description":"Arthroscopy, shoulder, surgical; with rotator cuff repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":902.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25316","name":"Revise palsy hand tendon(s)","description":"Flexor origin slide (eg, for cerebral palsy, volkmann contracture), forearm and/or wrist; with tendon(s) transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26479","name":"Shortening of hand tendon","description":"Shortening of tendon, flexor, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65275","name":"Repair of eye wound","description":"Repair of laceration; cornea, nonperforating, with or without removal foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87109","name":"Mycoplasma","description":"Culture, mycoplasma, any source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93292","name":"Wcd device interrogate","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22532","name":"Arthrd lat xtrcvtry tq thrc","description":"Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87389","name":"Hiv-1 ag w/hiv-1&-2 ab ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hiv-1 antigen(s), with hiv-1 and hiv-2 antibodies, single resu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72194","name":"Ct pelvis w/o & w/dye","description":"Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11606","name":"Exc tr-ext mal+marg >4 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27497","name":"Decompression of thigh/knee","description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":490.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92974","name":"Cath place cardio brachytx","description":"Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29882","name":"Arthrs kne srg mnisc rpr m/l","description":"Arthroscopy, knee, surgical; with meniscus repair (medial or lateral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0167","name":"Commode chair pail or pan","description":"Pail or pan for use with commode chair, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21820","name":"Treat sternum fracture","description":"Closed treatment of sternum fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6646","name":"Multipo locking shoulder jnt","description":"Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26358","name":"Repair/graft hand tendon","description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no mans land); secondary, with free graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62141","name":"Crnop skull defect>5 cm diam","description":"Cranioplasty for skull defect; larger than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7506","name":"Hmes/trachvalve adhesivedisk","description":"Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28119","name":"Removal of heel spur","description":"Ostectomy, calcaneus; for spur, with or without plantar fascial release","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95027","name":"Iq tsts seql&incrl airborne","description":"Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47400","name":"Incision of liver duct","description":"Hepaticotomy or hepaticostomy with exploration, drainage, or removal of calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0860","name":"Pwc gp3 vhd sing pow opt s/b","description":"Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65930","name":"Remove blood clot from eye","description":"Removal of blood clot, anterior segment of eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84120","name":"Assay of urine porphyrins","description":"Porphyrins, urine; quantitation and fractionation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0491","name":"Emr pwr source combo vad rep","description":"Emergency power source for use with electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":538.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95958","name":"Eeg monitoring/function test","description":"Wada activation test for hemispheric function, including electroencephalographic (eeg) monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91035","name":"G-esoph reflx tst w/electrod","description":"Esophagus, gastroesophageal reflux test; with mucosal attached telemetry ph electrode placement, recording, analysis and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40804","name":"Removal foreign body mouth","description":"Removal of embedded foreign body, vestibule of mouth; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24665","name":"Optx radial head/neck fx","description":"Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8628","name":"Cid ext controller repl","description":"Cochlear implant, external controller component, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64742","name":"Incision of facial nerve","description":"Transection or avulsion of; facial nerve, differential or complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":387.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76819","name":"Fetal biophys profil w/o nst","description":"Fetal biophysical profile; without non-stress testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6611","name":"Additional switch, ext power","description":"Addition to upper extremity prosthesis, external powered, additional switch, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54135","name":"Remove penis & nodes","description":"Amputation of penis, radical; in continuity with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44850","name":"Repair of mesentery","description":"Suture of mesentery (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":617.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0145","name":"Scr c/v cyto,thinlayer,rescr","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6925","name":"Wrist disart myoelectronic c","description":"Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3822.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35331","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; abdominal aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70210","name":"X-ray exam of sinuses","description":"Radiologic examination, sinuses, paranasal, less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29826","name":"Sho arthrs srg decompression","description":"Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0130","name":"Single energy x-ray study","description":"Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36473","name":"Endovenous mchnchem 1st vein","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25431","name":"Repair nonunion carpal bone","description":"Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":666.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00404","name":"Anes integ sys rad/modf brst","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27698","name":"Repair of ankle ligament","description":"Repair, secondary, disrupted ligament, ankle, collateral (eg, watson-jones procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52204","name":"Cystoscopy w/biopsy(s)","description":"Cystourethroscopy, with biopsy(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72285","name":"Discography cerv/thor spine","description":"Discography, cervical or thoracic, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66720","name":"Destruction ciliary body","description":"Ciliary body destruction; cryotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41113","name":"Excision of tongue lesion","description":"Excision of lesion of tongue with closure; posterior one-third","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23575","name":"Cltx scap fx w/mnpj +-tractj","description":"Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85305","name":"Clot inhibit prot s total","description":"Clotting inhibitors or anticoagulants; protein s, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37237","name":"Open/perq place stent ea add","description":"Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96121","name":"Nubhvl xm phy/qhp ea addl hr","description":"Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90785","name":"Psytx complex interactive","description":"Interactive complexity (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82642","name":"Dihydrotestosterone","description":"Dihydrotestosterone (dht)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44310","name":"Ileostomy/jejunostomy","description":"Ileostomy or jejunostomy, non-tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45384","name":"Colonoscopy w/lesion removal","description":"Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33284","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0854","name":"Pwc gp 3 xhd seat/back","description":"Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29819","name":"Sho arthrs srg rmvl loose/fb","description":"Arthroscopy, shoulder, surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33361","name":"Replace aortic valve perq","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; percutaneous femoral artery approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1054.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5810","name":"Endoskel knee-shin mnl lock","description":"Addition, endoskeletal knee-shin system, single axis, manual lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73565","name":"X-ray exam of knees","description":"Radiologic examination, knee; both knees, standing, anteroposterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34716","name":"Opn ax/subcla art expos cndt","description":"Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":325.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31502","name":"Change of windpipe airway","description":"Tracheotomy tube change prior to establishment of fistula tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28001","name":"Drainage of bursa of foot","description":"Incision and drainage, bursa, foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94781","name":"Cars/bd tst inft-12mo +30min","description":"Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; each additional full 30 minutes (list separately in addition to code","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28405","name":"Cltx calcaneal fx w/mnpj","description":"Closed treatment of calcaneal fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32562","name":"Lyse chest fibrin subq day","description":"Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); subsequent day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82016","name":"Acylcarnitines qual","description":"Acylcarnitines; qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44960","name":"Appendectomy","description":"Appendectomy; for ruptured appendix with abscess or generalized peritonitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93005","name":"Electrocardiogram tracing","description":"Electrocardiogram, routine ecg with at least 12 leads; tracing only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00942","name":"Anes vag px clptmy vgnc clpr","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); colpotomy, vaginectomy, colporrhaphy, and open urethral procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86631","name":"Chlamydia antibody","description":"Antibody; chlamydia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82528","name":"Assay of corticosterone","description":"Corticosterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20692","name":"Appl mltpln uni ext fixj sys","description":"Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, ilizarov, monticelli type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4633","name":"Uvl replacement bulb","description":"Replacement bulb/lamp for ultraviolet light therapy system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53000","name":"Incision of urethra","description":"Urethrotomy or urethrostomy, external (separate procedure); pendulous urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87252","name":"Virus inoculation tissue","description":"Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0141","name":"Scr c/v cyto,autosys and md","description":"Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82985","name":"Assay of glycated protein","description":"Glycated protein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0006","name":"Heavy duty wheelchair","description":"Heavy duty wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58555","name":"Hysteroscopy dx sep proc","description":"Hysteroscopy, diagnostic (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5624","name":"Test socket above knee","description":"Addition to lower extremity, test socket, above knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21125","name":"Augmentation mndblr prostc","description":"Augmentation, mandibular body or angle; prosthetic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87181","name":"Sc std agar dilution per agt","description":"Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26545","name":"Reconstruct finger joint","description":"Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":603.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5508","name":"Diabetic deluxe shoe","description":"For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24201","name":"Rmvl fb upper arm/elbw deep","description":"Removal of foreign body, upper arm or elbow area; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93931","name":"Upper extremity study","description":"Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1753","name":"Cath, intravas ultrasound","description":"Catheter, intravascular ultrasound","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":818.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3160","name":"Shoe styled positioning dev","description":"Foot, adjustable shoe-styled positioning device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54680","name":"Relocation of testis(es)","description":"Transplantation of testis(es) to thigh (because of scrotal destruction)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57160","name":"Insert pessary/other device","description":"Fitting and insertion of pessary or other intravaginal support device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58920","name":"Partial removal of ovary(s)","description":"Wedge resection or bisection of ovary, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86153","name":"Cell enumeration phys interp","description":"Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0454","name":"Tlso trnk sj-t9 pre cst","description":"Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35302","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; superficial femoral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":987.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93312","name":"Echo transesophageal","description":"Echocardiography, transesophageal, real-time with image documentation (2d) (with or without m-mode recording); including probe placement, image acquisition, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49406","name":"Image cath fluid peri/retro","description":"Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0540T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72040","name":"X-ray exam neck spine 2-3 vw","description":"Radiologic examination, spine, cervical; 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0296","name":"Hosp bed total elect w/ matt","description":"Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86382","name":"Neutralization test viral","description":"Neutralization test, viral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25670","name":"Optx rdcrpl/ntrcrpl dislc 1+","description":"Open treatment of radiocarpal or intercarpal dislocation, 1 or more bones","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1820","name":"Soft interface material","description":"Replacement soft interface material, dynamic adjustable extension/flexion device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36819","name":"Av fuse uppr arm basilic","description":"Arteriovenous anastomosis, open; by upper arm basilic vein transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5364","name":"Dysphagia screening","description":"Dysphagia screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86063","name":"Antistreptolysin o screen","description":"Antistreptolysin 0; screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86148","name":"Anti-phospholipid antibody","description":"Anti-phosphatidylserine (phospholipid) antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63300","name":"Remove vert xdrl body crvcl","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1658.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77307","name":"Telethx isodose plan cplx","description":"Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87809","name":"Adenovirus assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; adenovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15101","name":"Splt agrft t/a/l ea addl 100","description":"Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85335","name":"Factor inhibitor test","description":"Factor inhibitor test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55150","name":"Removal of scrotum","description":"Resection of scrotum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":400.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59850","name":"Induced abortion 1+ njx","description":"Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33419","name":"Repair tcat mitral valve","description":"Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47544","name":"Removal duct glbldr calculi","description":"Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (list sep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":763.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0484","name":"Monitor elec or comb vad rep","description":"Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93278","name":"Ecg/signal-averaged","description":"Signal-averaged electrocardiography (saecg), with or without ecg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77373","name":"Strtctc bdy rad ther tx dlvr","description":"Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81327","name":"Sept9 gen prmtr mthyltn alys","description":"Sept9 (septin9) (eg, colorectal cancer) promoter methylation analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0935","name":"Cont pas motion exercise dev","description":"Continuous passive motion exercise device for use on knee only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44025","name":"Incision of large bowel","description":"Colotomy, for exploration, biopsy(s), or foreign body removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":813.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22841","name":"Insert spine fixation device","description":"Internal spinal fixation by wiring of spinous processes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47145","name":"Prep donor liver lobe split","description":"Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe spli","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94200","name":"Lung function test (mbc/mvv)","description":"Maximum breathing capacity, maximal voluntary ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15570","name":"Skin pedicle flap trunk","description":"Formation of direct or tubed pedicle, with or without transfer; trunk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":583.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99485","name":"Suprv interfacilty transport","description":"Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data inter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22510","name":"Perq cervicothoracic inject","description":"Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1472.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88271","name":"Cytogenetics dna probe","description":"Molecular cytogenetics; dna probe, each (eg, fish)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22585","name":"Arthrd ant ntrbd min dsc ea","description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27488","name":"Removal of knee prosthesis","description":"Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1039","name":"Transport chair pt wt >300lb","description":"Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0470","name":"Tlso rigid frame pre subclav","description":"Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restr","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76775","name":"Us exam abdo back wall lim","description":"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17250","name":"Chem caut of granltj tissue","description":"Chemical cauterization of granulation tissue (ie, proud flesh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87633","name":"Resp virus 12-25 targets","description":"Infectious agent detection by nucleic acid (dna or rna); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33776","name":"Rpr tga atr bfl clsr vsd","description":"Repair of transposition of the great arteries, atrial baffle procedure (eg, mustard or senning type) with cardiopulmonary bypass; with closure of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1701.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77280","name":"Ther rad simulaj field smpl","description":"Therapeutic radiology simulation-aided field setting; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":221.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0243","name":"Toilet rail","description":"Toilet rail, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29868","name":"Meniscal trnspl knee w/scpe","description":"Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1418.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0493T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97150","name":"Group therapeutic procedures","description":"Therapeutic procedure(s), group (2 or more individuals)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6630","name":"Stainless steel any wrist","description":"Upper extremity addition, stainless steel, any wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00950","name":"Anes vag px culdoscopy","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); culdoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30801","name":"Ablate inf turbinate superf","description":"Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64421","name":"Njx aa&/strd ntrcost nrv ea","description":"Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6920","name":"Wrist disarticul switch ctrl","description":"Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15860","name":"Iv njx tst vasc flo flap/grf","description":"Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24635","name":"Optx monteggia fx dislc elbw","description":"Open treatment of monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0479","name":"Power module combo vad, rep","description":"Power module for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82261","name":"Assay of biotinidase","description":"Biotinidase, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54332","name":"Revise penis/urethra","description":"1-stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":819.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7037","name":"Pos airway pressure tubing","description":"Tubing used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63281","name":"Bx/exc idrl spine lesn thrc","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1914.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1310","name":"Whirlpool non-portable","description":"Whirlpool, non-portable (built-in type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64647","name":"Chemodenerv trunk musc 6/>","description":"Chemodenervation of trunk muscle(s); 6 or more muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86023","name":"Immunoglobulin assay","description":"Antibody identification; platelet associated immunoglobulin assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25250","name":"Removal of wrist prosthesis","description":"Removal of wrist prosthesis; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":447.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15773","name":"Grfg autol fat lipo 25 cc/<","description":"Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44147","name":"Partial removal of colon","description":"Colectomy, partial; abdominal and transanal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96170","name":"Hlth bhv ivntj fam wo pt 1st","description":"Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11772","name":"Exc pilonidal cyst comp","description":"Excision of pilonidal cyst or sinus; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00902","name":"Anes anorectal px","description":"Anesthesia for; anorectal procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67930","name":"Repair eyelid wound","description":"Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":223.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51720","name":"Treatment of bladder lesion","description":"Bladder instillation of anticarcinogenic agent (including retention time)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0165T","name":"Revise lumb artif disc addl","description":"Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2405","name":"Knee joint drop lock ea jnt","description":"Addition to knee joint, drop lock, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22853","name":"Insj biomechanical device","description":"Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (list separately in addition to code fo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0201T","name":"Perq sacral augmt bilat inj","description":"Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28675","name":"Repair of toe dislocation","description":"Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":463.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2014","name":"Post-d/c care plan overs 30m","description":"Limited (30 minutes) care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27067","name":"Remove/graft hip bone lesion","description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; with autograft requiring separate incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57283","name":"Colpopexy intraperitoneal","description":"Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61781","name":"Scan proc cranial intra","description":"Stereotactic computer-assisted (navigational) procedure; cranial, intradural (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01968","name":"Anes/analg cs dlvr neuraxial","description":"Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1652","name":"Ho bi thighcuffs w sprdr bar","description":"Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93740","name":"Temperature gradient studies","description":"Temperature gradient studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85337","name":"Thrombomodulin","description":"Thrombomodulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76950","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43340","name":"Fuse esophagus & intestine","description":"Esophagojejunostomy (without total gastrectomy); abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50325","name":"Prep donor renal graft","description":"Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76770","name":"Us exam abdo back wall comp","description":"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49460","name":"Fix g/colon tube w/device","description":"Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed, image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27557","name":"Treat knee dislocation","description":"Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91034","name":"Gastroesophageal reflux test","description":"Esophagus, gastroesophageal reflux test; with nasal catheter ph electrode(s) placement, recording, analysis and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83935","name":"Assay of urine osmolality","description":"Osmolality; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97750","name":"Physical performance test","description":"Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74410","name":"Urography nfs drip&/bolus","description":"Urography, infusion, drip technique and/or bolus technique;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61458","name":"Crnec sopl xpl/dcmpr crl nrv","description":"Craniectomy, suboccipital; for exploration or decompression of cranial nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1839.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84488","name":"Test feces for trypsin","description":"Trypsin; feces, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32855","name":"Prepare donor lung single","description":"Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0430","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23415","name":"Release of shoulder ligament","description":"Coracoacromial ligament release, with or without acromioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":587.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25909","name":"Amputation follow-up surgery","description":"Amputation, forearm, through radius and ulna; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11765","name":"Wedge excision skn nail fold","description":"Wedge excision of skin of nail fold (eg, for ingrown toenail)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64520","name":"N block lumbar/thoracic","description":"Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88162","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44386","name":"Endoscopy bowel pouch/biop","description":"Endoscopic evaluation of small intestinal pouch (eg, kock pouch, ileal reservoir [s or j]); with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95869","name":"Ndl emg thrc paraspinal musc","description":"Needle electromyography; thoracic paraspinal muscles (excluding t1 or t12)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36226","name":"Place cath vertebral art","description":"Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78140","name":"Red cell sequestration","description":"Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45005","name":"Drainage of rectal abscess","description":"Incision and drainage of submucosal abscess, rectum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27282","name":"Arthrodesis symphysis pubis","description":"Arthrodesis, symphysis pubis (including obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57110","name":"Vagnc compl rmvl vag wall","description":"Vaginectomy, complete removal of vaginal wall;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":576.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58322","name":"Artificial insemination","description":"Artificial insemination; intra-uterine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44626","name":"Repair bowel opening","description":"Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of hartmann type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15320","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20501","name":"Njx sinus tract diagnostic","description":"Injection of sinus tract; diagnostic (sinogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20696","name":"App mltpln uni xtrnl fix 1st","description":"Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":997.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8042","name":"Orbital prosthesis","description":"Orbital prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","KM","95","93","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22802","name":"Arthrd pst dfrm 7-12 vrt sgm","description":"Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1837.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4429","name":"Urine ost pouch w bltinconv","description":"Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99211","name":"Off/op est may x req phy/qhp","description":"Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52234","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; small bladder tumor(s) (0.5 up to 2.0 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75894","name":"X-rays transcath therapy","description":"Transcatheter therapy, embolization, any method, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":933.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50384","name":"Remove ureter stent percut","description":"Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63016","name":"Remove spine lamina >2 thrc","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1367.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66821","name":"After cataract laser surgery","description":"Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, yag laser) (1 or more stages)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21320","name":"Clsd tx nsl fx w/mnpj&stablj","description":"Closed treatment of nasal bone fracture with manipulation; with stabilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":206.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42100","name":"Biopsy roof of mouth","description":"Biopsy of palate, uvula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61305","name":"Crnec/crnot expl infratntorl","description":"Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96900","name":"Actinotherapy uv light","description":"Actinotherapy (ultraviolet light)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2623","name":"Plastic eye prosth custom","description":"Prosthetic eye, plastic, custom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57230","name":"Repair of urethral lesion","description":"Plastic repair of urethrocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33414","name":"Repair of aortic valve","description":"Repair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87272","name":"Cryptosporidium ag if","description":"Infectious agent antigen detection by immunofluorescent technique; cryptosporidium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78598","name":"Lung perf&ventilat diferentl","description":"Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2205","name":"Lens sphcy bifocal 4.00d/4.2","description":"Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0297","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":144.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99327","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44408","name":"Colonoscopy w/decompression","description":"Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97032","name":"Appl modality 1+estim ea 15","description":"Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28220","name":"Release of foot tendon","description":"Tenolysis, flexor, foot; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83858","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90473","name":"Immune admin oral/nasal","description":"Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4361","name":"Ostomy face plate","description":"Ostomy faceplate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3764","name":"Ewho w/joint(s) cf","description":"Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21627","name":"Sternal debridement","description":"Sternal debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":459.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61582","name":"Craniofacial approach skull","description":"Craniofacial approach to anterior cranial fossa; extradural, including unilateral or bifrontal craniotomy, elevation of frontal lobe(s), osteotomy of base of anterior cranial fossa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61591","name":"Infratemporal approach/skull","description":"Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, infratemporal fossa) including mastoidectomy, resection of sigmoid sinus, with or without decompression and/or mobilization of contents of auditory cana","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64890","name":"Nrv grf 1strnd hnd/foot <4cm","description":"Nerve graft (includes obtaining graft), single strand, hand or foot; up to 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":916.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32604","name":"Thoracoscopy wbx sac","description":"Thoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84207","name":"Assay of vitamin b-6","description":"Pyridoxal phosphate (vitamin b-6)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35800","name":"Explore neck vessels","description":"Exploration for postoperative hemorrhage, thrombosis or infection; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67808","name":"Remove eyelid lesion(s)","description":"Excision of chalazion; under general anesthesia and/or requiring hospitalization, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5726","name":"Knee-shin ext jnts fld swg e","description":"Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69155","name":"Extensive ear/neck surgery","description":"Radical excision external auditory canal lesion; with neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8513","name":"Trach pros cleaning device","description":"Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49507","name":"Prp i/hern init block >5 yr","description":"Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67250","name":"Reinforce eye wall","description":"Scleral reinforcement (separate procedure); without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72193","name":"Ct pelvis w/dye","description":"Computed tomography, pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":187.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29863","name":"Hip arthr0 w/synovectomy","description":"Arthroscopy, hip, surgical; with synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":686.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39401","name":"Mediastinoscpy w/medstnl bx","description":"Mediastinoscopy; includes biopsy(ies) of mediastinal mass (eg, lymphoma), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56640","name":"Vlvctmy rad comp w/lymphadec","description":"Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":959.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81007","name":"Urine screen for bacteria","description":"Urinalysis; bacteriuria screen, except by culture or dipstick","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85378","name":"Fibrin degrade semiquant","description":"Fibrin degradation products, d-dimer; qualitative or semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26250","name":"Extensive hand surgery","description":"Radical resection of tumor, metacarpal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27357","name":"Remove femur lesion/graft","description":"Excision or curettage of bone cyst or benign tumor of femur; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36120","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86140","name":"C-reactive protein","description":"C-reactive protein;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78803","name":"Rp loclzj tum spect 1 area","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect), single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61790","name":"Treat trigeminal nerve","description":"Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24201","name":"Rmvl fb upper arm/elbw deep","description":"Removal of foreign body, upper arm or elbow area; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73120","name":"X-ray exam of hand","description":"Radiologic examination, hand; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61154","name":"Burr hole w/evac&/drg hmtma","description":"Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1153.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30160","name":"Rhinectomy total","description":"Rhinectomy; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":593.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54120","name":"Partial removal of penis","description":"Amputation of penis; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44407","name":"Colonoscopy w/ndl aspir/bx","description":"Colonoscopy through stoma; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":211.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67820","name":"Revise eyelashes","description":"Correction of trichiasis; epilation, by forceps only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61521","name":"Removal of brain lesion","description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; midline tumor at base of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5230","name":"Fem focal defic constant fri","description":"Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59855","name":"Induced abortion 1+vag supp","description":"Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8044","name":"Hemi-facial prosthesis","description":"Hemi-facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2273.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73010","name":"X-ray exam of shoulder blade","description":"Radiologic examination; scapula, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62165","name":"Remove pituit tumor w/scope","description":"Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1334.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55801","name":"Removal of prostate","description":"Prostatectomy, perineal, subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35631","name":"Bpg aor-celiac-msn-renal","description":"Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G9041","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20610","name":"Drain/inj joint/bursa w/o us","description":"Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68705","name":"Revise tear duct opening","description":"Correction of everted punctum, cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0608","name":"Repl garment for aed","description":"Replacement garment for use with automated external defibrillator, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35112","name":"Repair artery rupture spleen","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, splenic artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27047","name":"Exc hip/pelvis les sc < 3 cm","description":"Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12057","name":"Intmd rpr face/mm >30.0 cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87270","name":"Chlamydia trachomatis ag if","description":"Infectious agent antigen detection by immunofluorescent technique; chlamydia trachomatis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2620","name":"Wc planar back cush wd <22in","description":"Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60271","name":"Removal of thyroid","description":"Thyroidectomy, including substernal thyroid; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12013","name":"Rpr f/e/e/n/l/m 2.6-5.0 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21435","name":"Optx crnfc sep comp int&/xtr","description":"Open treatment of craniofacial separation (lefort iii type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1181.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78103","name":"Bone marrow imaging mult","description":"Bone marrow imaging; multiple areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81289","name":"Fxn gene known famil variant","description":"Fxn (frataxin) (eg, friedreich ataxia) gene analysis; known familial variant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55000","name":"Drainage of hydrocele","description":"Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63740","name":"Install spinal shunt","description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; including laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":883.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77417","name":"Ther radiology port image(s)","description":"Therapeutic radiology port image(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33969","name":"Ecmo/ecls rmvl perph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75565","name":"Card mri veloc flow mapping","description":"Cardiac magnetic resonance imaging for velocity flow mapping (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74340","name":"X-ray guide for gi tube","description":"Introduction of long gastrointestinal tube (eg, miller-abbott), including multiple fluoroscopies and images, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35800","name":"Explore neck vessels","description":"Exploration for postoperative hemorrhage, thrombosis or infection; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26497","name":"Finger tendon transfer","description":"Transfer of tendon to restore intrinsic function; ring and small finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97545","name":"Work hardening","description":"Work hardening/conditioning; initial 2 hours","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27347","name":"Remove knee cyst","description":"Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67316","name":"Revise two eye muscles","description":"Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82088","name":"Assay of aldosterone","description":"Aldosterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26130","name":"Remove wrist joint lining","description":"Synovectomy, carpometacarpal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1224","name":"Wheelchair spec size w/ leg","description":"Wheelchair with detachable arms, elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0930","name":"Fracture frame free standing","description":"Fracture frame, free standing, includes weights","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90808","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5570","name":"Prep ak ischial direct form","description":"Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1135.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0167","name":"Commode chair pail or pan","description":"Pail or pan for use with commode chair, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97039","name":"Unlisted modality","description":"Unlisted modality (specify type and time if constant attendance)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2611","name":"Gen use back cush wdth <22in","description":"General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86077","name":"Phys blood bank serv xmatch","description":"Blood bank physician services; difficult cross match and/or evaluation of irregular antibody(s), interpretation and written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99378","name":"Hospice care supervision","description":"Supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47142","name":"Partial removal donor liver","description":"Donor hepatectomy (including cold preservation), from living donor; total right lobectomy (segments v, vi, vii and viii)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27830","name":"Treat lower leg dislocation","description":"Closed treatment of proximal tibiofibular joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33845","name":"Excision coa w/graft","description":"Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1154.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5712","name":"Knee-shin exo frict swg & st","description":"Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4414","name":"Ost sknbar w/o conv<=4 sq in","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80103","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34804","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1060.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33530","name":"Coronary artery bypass/reop","description":"Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2209","name":"Arm trough each","description":"Accessory, arm trough, with or without hand support, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80170","name":"Assay of gentamicin","description":"Gentamicin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4060","name":"Replace high roll cuff","description":"Replace high roll cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62223","name":"Establish brain cavity shunt","description":"Creation of shunt; ventriculo-peritoneal, -pleural, other terminus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":935.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72275","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77063","name":"Breast tomosynthesis bi","description":"Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4927","name":"Non-sterile gloves","description":"Gloves, non-sterile, per 100","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0037","name":"Hi mount flip-up footrest ea","description":"High mount flip-up footrest, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33750","name":"Shunt subclavian to pulm art","description":"Shunt; subclavian to pulmonary artery (blalock-taussig type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1096.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4623","name":"Tracheostomy inner cannula","description":"Tracheostomy, inner cannula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77066","name":"Dx mammo incl cad bi","description":"Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21339","name":"Open nasoethmoid fx w/ fixj","description":"Open treatment of nasoethmoid fracture; with external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":605.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11006","name":"Dbrdmt skin xtrnl gent per","description":"Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0514","name":"Prolong prev svcs, addl 30m","description":"Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6300","name":"Shlder disart int lock elbow","description":"Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2243.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36584","name":"Compl rplcmt picc rs&i","description":"Replacement, complete, of a peripherally inserted central venous catheter (picc), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0636","name":"Lso sagittal rigid panel cus","description":"Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":703.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28080","name":"Removal of foot lesion","description":"Excision, interdigital (morton) neuroma, single, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4252","name":"Blood ketone test or strip","description":"Blood ketone test or reagent strip, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7032","name":"Replacement nasal cushion","description":"Cushion for use on nasal mask interface, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26445","name":"Release hand/finger tendon","description":"Tenolysis, extensor tendon, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83497","name":"Assay of 5-hiaa","description":"Hydroxyindolacetic acid, 5-(hiaa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98943","name":"Chiropract manj xtrspinl 1/>","description":"Chiropractic manipulative treatment (cmt); extraspinal, 1 or more regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23146","name":"Removal of bone lesion","description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66680","name":"Repair iris & ciliary body","description":"Repair of iris, ciliary body (as for iridodialysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":312.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73220","name":"Mri uppr extremity w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":378.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15953","name":"Exc trchntr pr ulc flp ostc","description":"Excision, trochanteric pressure ulcer, with skin flap closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":644.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35693","name":"Art trnsposj subclavian","description":"Transposition and/or reimplantation; vertebral to subclavian artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35141","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral artery (profunda femoris, superficial femoral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2310","name":"Abduction bar-straight","description":"Addition to lower extremity, abduction bar-straight","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57020","name":"Colpocentesis sep px","description":"Colpocentesis (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33264","name":"Rmvl & rplcmt dfb gen mlt ld","description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1005","name":"Tension based scoliosis orth","description":"Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1556.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7507","name":"Integrated filter & holder","description":"Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24310","name":"Tnot opn elbw to sho ea tdn","description":"Tenotomy, open, elbow to shoulder, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":394.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0246","name":"Followup eval of foot pt lop","description":"Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0310","name":"Rails bed side full length","description":"Bed side rails, full length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70542","name":"Mri orbit/face/neck w/dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61521","name":"Removal of brain lesion","description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; midline tumor at base of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2943.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76080","name":"X-ray exam of fistula","description":"Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01991","name":"Anes dx/ther nrv blk&inj oth","description":"Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); other than the prone position","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35286","name":"Rpr blvsl grf oth/th vn lxtr","description":"Repair blood vessel with graft other than vein; lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5649","name":"Isch containmt/narrow m-l so","description":"Addition to lower extremity, ischial containment/narrow m-l socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3901","name":"Hinge ext/flex wrist finger","description":"Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":810.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2218","name":"Foam propulsion tire each","description":"Manual wheelchair accessory, foam propulsion tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37209","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49496","name":"Rpr ing hernia baby blocked","description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6532","name":"Compress stking bk40-50 surg","description":"Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86618","name":"Lyme disease antibody","description":"Antibody; borrelia burgdorferi (lyme disease)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95933","name":"Blink reflex test","description":"Orbicularis oculi (blink) reflex, by electrodiagnostic testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65091","name":"Revise eye","description":"Evisceration of ocular contents; without implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":417.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33814","name":"Obltrj a-pulm sep def w/byp","description":"Obliteration of aortopulmonary septal defect, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1320.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00300","name":"Anes all px integ h/n/ptrunk","description":"Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33866","name":"Aortic hemiarch graft","description":"Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2626","name":"Reduction of eye prosthesis","description":"Reduction of ocular prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53446","name":"Remove uro sphincter","description":"Removal of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47147","name":"Prep donor liver/arterial","description":"Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74400","name":"Urography iv +-kub tomog","description":"Urography (pyelography), intravenous, with or without kub, with or without tomography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1037","name":"Transport chair, ped size","description":"Transport chair, pediatric size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1660","name":"Ho abduction static plastic","description":"Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33858","name":"As-aort grf f/aortic dsj","description":"Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2964.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55873","name":"Cryoablate prostate","description":"Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4988.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35683","name":"Composite byp grft 3/> segmt","description":"Bypass graft; autogenous composite, 3 or more segments of vein from 2 or more locations (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35452","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20950","name":"Mntr intrstitial fluid press","description":"Monitoring of interstitial fluid pressure (includes insertion of device, eg, wick catheter technique, needle manometer technique) in detection of muscle compartment syndrome","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43228","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4931","name":"Reusable oral thermometer","description":"Oral thermometer, reusable, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85652","name":"Rbc sed rate automated","description":"Sedimentation rate, erythrocyte; automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5679","name":"Socket insert w/o lock mech","description":"Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21470","name":"Optx complicated mndblr fx","description":"Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93286","name":"Peri-px eval pm/ldls pm ip","description":"Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11620","name":"Exc h-f-nk-sp mal+marg 0.5/<","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64565","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24147","name":"Prtl exc bone olecrn process","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), olecranon process","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5638","name":"Below knee leather socket","description":"Addition to lower extremity, below knee, leather socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0102","name":"Prostate ca screening; dre","description":"Prostate cancer screening; digital rectal examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28090","name":"Removal of foot lesion","description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21295","name":"Revision of jaw muscle/bone","description":"Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); extraoral approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8415","name":"Sheath upper limb","description":"Prosthetic sheath, upper limb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98975","name":"Rtm 1st set-up&pt educaj eqp","description":"Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); initial set-up and patient education on use of equipment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33430","name":"Replacement of mitral valve","description":"Replacement, mitral valve, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31287","name":"Nasal/sinus endoscopy surg","description":"Nasal/sinus endoscopy, surgical, with sphenoidotomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77021","name":"Mri guidance ndl plmt rs&i","description":"Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80162","name":"Assay of digoxin total","description":"Digoxin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93583","name":"Perq transcath septal reduxn","description":"Percutaneous transcatheter septal reduction therapy (eg, alcohol septal ablation) including temporary pacemaker insertion when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":794.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86510","name":"Histoplasmosis skin test","description":"Skin test; histoplasmosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36010","name":"Place catheter in vein","description":"Introduction of catheter, superior or inferior vena cava","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5505","name":"Diab shoe w/metatarsal bar","description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0869","name":"Pwc gp 4 std cap chair","description":"Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64786","name":"Remove sciatic nerve lesion","description":"Excision of neuroma; sciatic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":879.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00842","name":"Anes iper px amniocentesis","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; amniocentesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5645","name":"Bk flex inner socket ext fra","description":"Addition to lower extremity, below knee, flexible inner socket, external frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70547","name":"Mr angiography neck w/o dye","description":"Magnetic resonance angiography, neck; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0237","name":"Therapeutic procd strg endur","description":"Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21345","name":"Closed tx nose/jaw fx","description":"Closed treatment of nasomaxillary complex fracture (lefort ii type), with interdental wire fixation or fixation of denture or splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68320","name":"Revise/graft eyelid lining","description":"Conjunctivoplasty; with conjunctival graft or extensive rearrangement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":448.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24940","name":"Revision of upper arm","description":"Cineplasty, upper extremity, complete procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":501.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6588","name":"Shdr fair lead cable molded","description":"Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1431.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50820","name":"Construct bowel bladder","description":"Ureteroileal conduit (ileal bladder), including intestine anastomosis (bricker operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21616","name":"Exc 1st&/crv rib w/sympth","description":"Excision first and/or cervical rib; with sympathectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1902","name":"Afo ankle gauntlet pre ots","description":"Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2252","name":"Brief chkin by md/qhp, 11-20","description":"Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor le","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87073","name":"Culture bacteria anaerobic","description":"Culture, bacterial; quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21685","name":"Hyoid myotomy & suspension","description":"Hyoid myotomy and suspension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":798.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94640","name":"Airway inhalation treatment","description":"Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (ippb) device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52649","name":"Prostate laser enucleation","description":"Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":668.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27222","name":"Treat hip socket fracture","description":"Closed treatment of acetabulum (hip socket) fracture(s); with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63283","name":"Bx/exc idrl spine lesn scrl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58560","name":"Hysteroscopy resect septum","description":"Hysteroscopy, surgical; with division or resection of intrauterine septum (any method)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83491","name":"Asy hydroxycorticosteroids17","description":"Hydroxycorticosteroids, 17- (17-ohcs)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93564","name":"Njx cgen car cath slctv opac","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0466T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26055","name":"Incise finger tendon sheath","description":"Tendon sheath incision (eg, for trigger finger)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4367","name":"Ostomy belt","description":"Ostomy belt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83520","name":"Immunoassay quant nos nonab","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33390","name":"Valvuloplasty aortic valve","description":"Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (ie, valvotomy, debridement, debulking, and/or simple commissural resuspension)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28112","name":"Part removal of metatarsal","description":"Ostectomy, complete excision; other metatarsal head (second, third or fourth)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93721","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00322","name":"Anes all px nck ndl bx thyr","description":"Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; needle biopsy of thyroid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86803","name":"Hepatitis c ab test","description":"Hepatitis c antibody;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1843","name":"Ko single upright pre cst","description":"Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a sp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":436.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11606","name":"Exc tr-ext mal+marg >4 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42510","name":"Parotid duct diversion","description":"Parotid duct diversion, bilateral (wilke type procedure); with ligation of both submandibular (whartons) ducts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92630","name":"Aud rehab pre-ling hear loss","description":"Auditory rehabilitation; prelingual hearing loss","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20101","name":"Expl pentrg wound chest","description":"Exploration of penetrating wound (separate procedure); chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76978","name":"Us trgt dyn mbubb 1st les","description":"Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44147","name":"Partial removal of colon","description":"Colectomy, partial; abdominal and transanal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1601.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43652","name":"Laparoscopy vagus nerve","description":"Laparoscopy, surgical; transection of vagus nerves, selective or highly selective","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47371","name":"Laparo ablate liver cryosurg","description":"Laparoscopy, surgical, ablation of 1 or more liver tumor(s); cryosurgical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35572","name":"Harvest femoropopliteal vein","description":"Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73610","name":"X-ray exam of ankle","description":"Radiologic examination, ankle; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44212","name":"Laparo total proctocolectomy","description":"Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1628.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61624","name":"Tcat perm occls/embolj cns","description":"Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), including all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention, percutaneous,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1015.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0306","name":"Cbc/diffwbc w/o platelet","description":"Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99464","name":"Attendance at delivery","description":"Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84630","name":"Assay of zinc","description":"Zinc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54105","name":"Biopsy of penis","description":"Biopsy of penis; deep structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84156","name":"Assay of protein urine","description":"Protein, total, except by refractometry; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87880","name":"Strep a assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; streptococcus, group a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24102","name":"Arthrt elbow w/synovectomy","description":"Arthrotomy, elbow; with synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":516.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6586","name":"Elbow fair lead cable dir fo","description":"Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12057","name":"Intmd rpr face/mm >30.0 cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":385.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44015","name":"Insert needle cath bowel","description":"Tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80402","name":"Acth stimulation panel","description":"Acth stimulation panel; for 21 hydroxylase deficiency this panel must include the following: cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99205","name":"Office o/p new hi 60 min","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49592","name":"Rpr aa hrn 1st < 3 ncr/strn","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01922","name":"Anes n-invas img/radj ther","description":"Anesthesia for non-invasive imaging or radiation therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5671","name":"Bk/ak locking mechanism","description":"Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21147","name":"Rcnstj mdfc lefort i 3/>grf","description":"Reconstruction midface, lefort i; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99458","name":"Rpm tx mgmt ea addl 20 min","description":"Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring 1 real-time interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (list separately in","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34711","name":"Dlyd plmt xtn prosth ea addl","description":"Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":262.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88187","name":"Flowcytometry/read 2-8","description":"Flow cytometry, interpretation; 2 to 8 markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35500","name":"Harvest vein for bypass","description":"Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90847","name":"Family psytx w/pt 50 min","description":"Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22515","name":"Perq vertebral augmentation","description":"Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3011.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92992","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":561.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74170","name":"Ct abd wo cntrst flwd cntrst","description":"Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54200","name":"Injection px peyronie ds","description":"Injection procedure for peyronie disease;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22505","name":"Manipulation of spine","description":"Manipulation of spine requiring anesthesia, any region","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61531","name":"Implant brain electrodes","description":"Subdural implantation of strip electrodes through 1 or more burr or trephine hole(s) for long-term seizure monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82507","name":"Assay of citrate","description":"Citrate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29365","name":"Appl cylinder cast","description":"Application of cylinder cast (thigh to ankle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87807","name":"Rsv assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54300","name":"Revision of penis","description":"Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0491","name":"Tlso 2 piece rigid shell","description":"Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":373.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11305","name":"Shave skin lesion 0.5 cm/<","description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72131","name":"Ct lumbar spine w/o dye","description":"Computed tomography, lumbar spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21610","name":"Costotransversectomy","description":"Costotransversectomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49418","name":"Insert tun ip cath perc","description":"Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4316","name":"Cath w/drainage 3-way","description":"Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3984","name":"Upper ext fx orthosis wrist","description":"Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2226","name":"Caster fork replacement only","description":"Manual wheelchair accessory, caster fork, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0238T","name":"Trluml perip athrc iliac art","description":"Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9507.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82310","name":"Assay of calcium","description":"Calcium; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0620","name":"Cap bld skin piercing laser","description":"Skin piercing device for collection of capillary blood, laser, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26852","name":"Fusion of knuckle with graft","description":"Arthrodesis, metacarpophalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87106","name":"Fungi identification yeast","description":"Culture, fungi, definitive identification, each organism; yeast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27519","name":"Treat thigh fx growth plate","description":"Open treatment of distal femoral epiphyseal separation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":756.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"D1206","name":"Topical fluoride varnish","description":"Topical fluoride varnish; therapeutic application for moderate to high caries risk patients","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12007","name":"Rpr s/n/ax/gen/trnk >30.0 cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00400","name":"Anes integumentary sys nos","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76641","name":"Ultrasound breast complete","description":"Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73560","name":"X-ray exam of knee 1 or 2","description":"Radiologic examination, knee; 1 or 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0239","name":"Hydrocollator unit portable","description":"Hydrocollator unit, portable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83861","name":"Microfluid analy tears","description":"Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32800","name":"Repair lung hernia","description":"Repair lung hernia through chest wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35151","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, popliteal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1089.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7525","name":"Tracheostomy mask","description":"Tracheostomy mask, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3978","name":"Sewhfo airplane w/jnt(s) cf","description":"Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42845","name":"Extensive surgery of throat","description":"Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with other flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71022","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73600","name":"X-ray exam of ankle","description":"Radiologic examination, ankle; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72114","name":"X-ray exam l-s spine bending","description":"Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61596","name":"Transcochlear approach/skull","description":"Transcochlear approach to posterior cranial fossa, jugular foramen or midline skull base, including labyrinthectomy, decompression, with or without mobilization of facial nerve and/or petrous carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1991.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38740","name":"Remove armpit lymph nodes","description":"Axillary lymphadenectomy; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58573","name":"Tlh w/t/o uterus over 250 g","description":"Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95147","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 3 single stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94690","name":"O2 uptk rest indirect","description":"Oxygen uptake, expired gas analysis; rest, indirect (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83727","name":"Assay of lrh hormone","description":"Luteinizing releasing factor (lrh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97530","name":"Therapeutic activities","description":"Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57135","name":"Excision vaginal cyst/tumor","description":"Excision of vaginal cyst or tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80422","name":"Glucagon tolerance panel","description":"Glucagon tolerance panel; for insulinoma this panel must include the following: glucose (82947 x 3) insulin (83525 x 3)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23170","name":"Sequestrectomy clavicle","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89105","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70480","name":"Ct orbit/ear/fossa w/o dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92943","name":"Prq trluml revsc ch occ ant","description":"Percutaneous transluminal revascularization of chronic total occlusion, single coronary artery, coronary artery branch, or coronary artery bypass graft, and/or subtended major coronary artery branches of the bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; antegrade","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0075T","name":"Perq stent/chest vert art","description":"Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2011","name":"Alcohol/sub misuse assess","description":"Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5668","name":"Bk molded distal cushion","description":"Addition  to lower extremity, below knee, molded distal cushion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35682","name":"Composite byp grft 2 veins","description":"Bypass graft; autogenous composite, 2 segments of veins from 2 locations (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B5000","name":"Parenteral sol renal-amirosy","description":"Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal-aminosyn-rf, nephramine, renamine-premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0669","name":"Seg pneumatic appli half leg","description":"Segmental pneumatic appliance for use with pneumatic compressor, half leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25100","name":"Biopsy of wrist joint","description":"Arthrotomy, wrist joint; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88312","name":"Special stains group 1","description":"Special stain including interpretation and report; group i for microorganisms (eg, acid fast, methenamine silver)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5160","name":"Mold socket bent knee shin s","description":"Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1895.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00866","name":"Anes xtrprt lw abd adrnlctmy","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; adrenalectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54530","name":"Removal of testis","description":"Orchiectomy, radical, for tumor; inguinal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82952","name":"Gtt-added samples","description":"Glucose; tolerance test, each additional beyond 3 specimens (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43410","name":"Repair esophagus wound","description":"Suture of esophageal wound or injury; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":795.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61584","name":"Orbitocranial approach/skull","description":"Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); without orbital exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2584.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84620","name":"Xylose tolerance test","description":"Xylose absorption test, blood and/or urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73202","name":"Ct uppr extremity w/o&w/dye","description":"Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22840","name":"Insert spine fixation device","description":"Posterior non-segmental instrumentation (eg, harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at c1, facet screw fixation) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":679.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49435","name":"Insert subq exten to ip cath","description":"Insertion of subcutaneous extension to intraperitoneal cannula or catheter with remote chest exit site (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28456","name":"Prq skel fix tarsl fx w/mnpj","description":"Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43122","name":"Partial removal of esophagus","description":"Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with esophagogastrostomy, with or without pyloroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2131.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12051","name":"Intmd rpr face/mm 2.5 cm/<","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0328","name":"Ped hospital bed, manual","description":"Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4502.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00546","name":"Anes thrcm px pulm rescj","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); pulmonary resection with thoracoplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29058","name":"Appl cast plaster velpeau","description":"Application, cast; plaster velpeau","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2492","name":"Knee lift loop drop lock rin","description":"Addition to knee joint, lift loop for drop lock ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23900","name":"Interthoracoscplr amputation","description":"Interthoracoscapular amputation (forequarter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64856","name":"Repair/transpose nerve","description":"Suture of major peripheral nerve, arm or leg, except sciatic; including transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64774","name":"Remove skin nerve lesion","description":"Excision of neuroma; cutaneous nerve, surgically identifiable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21501","name":"I&d dp absc/hmtma sft ts nck","description":"Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78306","name":"Bone imaging whole body","description":"Bone and/or joint imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62252","name":"Csf shunt reprogram","description":"Reprogramming of programmable cerebrospinal shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4641","name":"Radiopharm dx agent noc","description":"Radiopharmaceutical, diagnostic, not otherwise classified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70140","name":"X-ray exam of facial bones","description":"Radiologic examination, facial bones; less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74328","name":"X-ray bile duct endoscopy","description":"Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24341","name":"Rpr tdn/musc upr a/e each","description":"Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":624.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31634","name":"Bronch w/balloon occlusion","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (eg, fibrin glue), if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24200","name":"Rmvl fb upper arm/elbw subq","description":"Removal of foreign body, upper arm or elbow area; subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54405","name":"Insert multi-comp penis pros","description":"Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":655.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44970","name":"Laparoscopy appendectomy","description":"Laparoscopy, surgical, appendectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92240","name":"Icg angiography i&r uni/bi","description":"Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42806","name":"Biopsy of upper nose/throat","description":"Biopsy; nasopharynx, survey for unknown primary lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6621","name":"Flex/ext wrist w/wo friction","description":"Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17314","name":"Mohs addl stage t/a/l","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88160","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; screening and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29200","name":"Strapping thorax","description":"Strapping; thorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27454","name":"Realignment of thigh bone","description":"Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (eg, sofield type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01220","name":"Anes clsd px upper 2/3 femur","description":"Anesthesia for all closed procedures involving upper two-thirds of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69424","name":"Remove ventilating tube","description":"Ventilating tube removal requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53515","name":"Repair of urethra injury","description":"Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":644.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61710","name":"Revise circulation to head","description":"Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intra-arterial embolization, injection procedure, or balloon catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1972.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33946","name":"Ecmo/ecls initiation venous","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; initiation, veno-venous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11042","name":"Dbrdmt subq tis 1st 20sqcm/<","description":"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30140","name":"Resect inferior turbinate","description":"Submucous resection inferior turbinate, partial or complete, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00912","name":"Anes trurl px rescj bldr tum","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of bladder tumor(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45393","name":"Colonoscopy w/decompression","description":"Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":196.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45135","name":"Excision of rectal prolapse","description":"Excision of rectal procidentia, with anastomosis; abdominal and perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3808","name":"Whfo, rigid w/o joints","description":"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15276","name":"Skin sub graft f/n/hf/g addl","description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40490","name":"Biopsy of lip","description":"Biopsy of lip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42508","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":537.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95829","name":"Surgery electrocorticogram","description":"Electrocorticogram at surgery (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27178","name":"Treat slipped epiphysis","description":"Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8630","name":"Metacarpophalangeal implant","description":"Metacarpophalangeal joint implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69636","name":"Rebuild eardrum structures","description":"Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44361","name":"Small bowel endoscopy/biopsy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93985","name":"Dup-scan hemo compl bi std","description":"Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP22","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0433","name":"Portable liquid oxygen sys","description":"Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89055","name":"Leukocyte assessment fecal","description":"Leukocyte assessment, fecal, qualitative or semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78701","name":"Kidney imaging with flow","description":"Kidney imaging morphology; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0920","name":"Fracture frame attached to b","description":"Fracture frame, attached to bed, includes weights","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36218","name":"Place catheter in artery","description":"Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2604","name":"Skin protect wc cus wd>=22in","description":"Skin protection wheelchair seat cushion, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61795","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26735","name":"Treat finger fracture each","description":"Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":495.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76979","name":"Us trgt dyn mbubb ea addl","description":"Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate injection (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2313","name":"Lens sphc trifo 7.25-12/4.25","description":"Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52640","name":"Relieve bladder contracture","description":"Transurethral resection; of postoperative bladder neck contracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27613","name":"Biopsy lower leg soft tissue","description":"Biopsy, soft tissue of leg or ankle area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0518","name":"Remove w insert drug implant","description":"Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35390","name":"Reoperation carotid add-on","description":"Reoperation, carotid, thromboendarterectomy, more than 1 month after original operation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84165","name":"Protein e-phoresis serum","description":"Protein; electrophoretic fractionation and quantitation, serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31760","name":"Tracheoplasty intrathoracic","description":"Tracheoplasty; intrathoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1095.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6220","name":"Gauze >16 <=48 sq in w/bordr","description":"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74183","name":"Mri abd w/o cntr flwd cntr","description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44850","name":"Repair of mesentery","description":"Suture of mesentery (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35456","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50545","name":"Laparo radical nephrectomy","description":"Laparoscopy, surgical; radical nephrectomy (includes removal of gerotas fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6005","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31766","name":"Carinal reconstruction","description":"Carinal reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1423.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22903","name":"Exc abd les sc 3 cm/>","description":"Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67210","name":"Treatment of retinal lesion","description":"Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93283","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantab","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93040","name":"Rhythm ecg with report","description":"Rhythm ecg, 1-3 leads; with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49446","name":"Change g-tube to g-j perc","description":"Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":691.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67316","name":"Revise two eye muscles","description":"Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":482.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35540","name":"Art byp grft aortbifemoral","description":"Bypass graft, with vein; aortobifemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3660","name":"So 8 ab rstr can/web pre ots","description":"Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15734","name":"Muscle-skin graft trunk","description":"Muscle, myocutaneous, or fasciocutaneous flap; trunk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":987.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41872","name":"Gingivoplasty each quadrant","description":"Gingivoplasty, each quadrant (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50686","name":"Measure ureter pressure","description":"Manometric studies through ureterostomy or indwelling ureteral catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55550","name":"Laparo ligate spermatic vein","description":"Laparoscopy, surgical, with ligation of spermatic veins for varicocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S0191","name":"Misoprostol, oral, 200 mcg","description":"Misoprostol, oral, 200 mcg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25606","name":"Perq skel fixj dstl rdl fx","description":"Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00176","name":"Anes intraoral px rad surg","description":"Anesthesia for intraoral procedures, including biopsy; radical surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82742","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33228","name":"Remv&replc pm gen dual lead","description":"Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51705","name":"Change of bladder tube","description":"Change of cystostomy tube; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0325","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50800","name":"Implant ureter in bowel","description":"Ureteroenterostomy, direct anastomosis of ureter to intestine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45305","name":"Proctosigmoidoscopy w/bx","description":"Proctosigmoidoscopy, rigid; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0555","name":"Humidifier for use w/ regula","description":"Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62145","name":"Repair of skull & brain","description":"Cranioplasty for skull defect with reparative brain surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7016","name":"Nebulizer dome & mouthpiece","description":"Dome and mouthpiece, used with small volume ultrasonic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31531","name":"Laryngoscopy w/fb & op scope","description":"Laryngoscopy, direct, operative, with foreign body removal; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33859","name":"As-aort grf f/ds oth/thn dsj","description":"Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2126.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5510","name":"Compression form shoe insert","description":"For diabetics only, direct formed, compression molded to patients foot without external heat source, multiple-density insert(s) prefabricated, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27870","name":"Fusion of ankle joint open","description":"Arthrodesis, ankle, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55840","name":"Extensive prostate surgery","description":"Prostatectomy, retropubic radical, with or without nerve sparing;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99344","name":"Home/res vst new mod mdm 60","description":"Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4554","name":"Disposable underpads","description":"Disposable underpads, all sizes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33771","name":"Rpr tga w/surg enlgmnt vsd","description":"Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; with surgical enlargement of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1900.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58270","name":"Vag hyst w/enterocele repair","description":"Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":571.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86367","name":"Stem cells total count","description":"Stem cells (ie, cd34), total count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0248","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87081","name":"Culture screen only","description":"Culture, presumptive, pathogenic organisms, screening only;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0305","name":"Rails bed side half length","description":"Bed side rails, half length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5665","name":"Multi-durometer below knee","description":"Addition to lower extremity, socket insert, multi-durometer, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29899","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61651","name":"Evasc prlng admn rx agnt add","description":"Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each additional vascular territory (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65112","name":"Remove eye/revise socket","description":"Exenteration of orbit (does not include skin graft), removal of orbital contents; with therapeutic removal of bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":883.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2795","name":"Knee control full kneecap","description":"Addition to lower extremity orthosis, knee control, full kneecap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31578","name":"Largsc w/removal lesion","description":"Laryngoscopy, flexible; with removal of lesion(s), non-laser","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19110","name":"Nipple exploration","description":"Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76391","name":"Mr elastography","description":"Magnetic resonance (eg, vibration) elastography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4197","name":"Parenteral sol 74-100 gm pro","description":"Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":168.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31267","name":"Endoscopy maxillary sinus","description":"Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33600","name":"Closure of valve","description":"Closure of atrioventricular valve (mitral or tricuspid) by suture or patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1490.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0984","name":"Add pwr tiller","description":"Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32200","name":"Drain open lung lesion","description":"Pneumonostomy, with open drainage of abscess or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88318","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0247","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55250","name":"Removal of sperm duct(s)","description":"Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77300","name":"Radiation therapy dose plan","description":"Basic radiation dosimetry calculation, central axis depth dose calculation, tdf, nsd, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25907","name":"Amputation follow-up surgery","description":"Amputation, forearm, through radius and ulna; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":517.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96934","name":"Rcm img acquisj&i&r ea addl","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93641","name":"Ep evl 1/2chmb pac cvdfb tst","description":"Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":648.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4580","name":"Cast supplies (plaster)","description":"Cast supplies (e.g., plaster)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28312","name":"Revision of toe","description":"Osteotomy, shortening, angular or rotational correction; other phalanges, any toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":407.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00862","name":"Anes xtrprtl lwr abd rnl px","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one-third of ureter, or donor nephrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63198","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1914.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67974","name":"Reconstruction of eyelid","description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86735","name":"Mumps antibody","description":"Antibody; mumps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94013","name":"Meas lung vol thru 2 yrs","description":"Measurement of lung volumes (ie, functional residual capacity [frc], forced vital capacity [fvc], and expiratory reserve volume [erv]) in an infant or child through 2 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82274","name":"Assay test for blood fecal","description":"Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30462","name":"Revision of nose","description":"Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43100","name":"Excision of esophagus lesion","description":"Excision of lesion, esophagus, with primary repair; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63276","name":"Bx/exc xdrl spine lesn thrc","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7521","name":"Trach/laryn tube cuffed","description":"Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28270","name":"Release of foot contracture","description":"Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":399.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34712","name":"Tcat dlvr enhncd fixj dev","description":"Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":575.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79101","name":"Nuclear rx iv admin","description":"Radiopharmaceutical therapy, by intravenous administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86774","name":"Tetanus antibody","description":"Antibody; tetanus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88720","name":"Bilirubin total transcut","description":"Bilirubin, total, transcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84377","name":"Sugars multiple qual","description":"Sugars (mono-, di-, and oligosaccharides); multiple qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1004","name":"Pwr seat recline mech","description":"Wheelchair accessory, power seating system, recline only, with mechanical shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33803","name":"Div aberrant vsl w/reanast","description":"Division of aberrant vessel (vascular ring); with reanastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43510","name":"Surgical opening of stomach","description":"Gastrotomy; with esophageal dilation and insertion of permanent intraluminal tube (eg, celestin or mousseaux-barbin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":793.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92311","name":"Contact lens fitg aphakia 1","description":"Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, 1 eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78220","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43865","name":"Revj gstr/jj anast w/vgtmy","description":"Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; with vagotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36479","name":"Endovenous laser vein addon","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50323","name":"Prep cadaver renal allograft","description":"Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58275","name":"Hysterectomy/revise vagina","description":"Vaginal hysterectomy, with total or partial vaginectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":632.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15853","name":"Removal sutr/stapl xreq anes","description":"Removal of sutures or staples not requiring anesthesia (list separately in addition to e/m code)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0012","name":"Ltwt portbl power whlchr","description":"Lightweight portable motorized/power wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93788","name":"Ambl bp mntr w/sw a/r","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; scanning analysis with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75968","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50384","name":"Remove ureter stent percut","description":"Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":722.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0296","name":"Hosp bed total elect w/ matt","description":"Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0605","name":"Vaporizer room type","description":"Vaporizer, room type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26510","name":"Thumb tendon transfer","description":"Cross intrinsic transfer, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15278","name":"Skn sub grft f/n/hf/g ch add","description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29897","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":413.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33510","name":"Cabg vein single","description":"Coronary artery bypass, vein only; single coronary venous graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1681.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6199","name":"Alginate drsg wound filler","description":"Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62326","name":"Njx interlaminar lmbr/sac","description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21040","name":"Excise mandible lesion","description":"Excision of benign tumor or cyst of mandible, by enucleation and/or curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01140","name":"Anes ntrplvabdmnl amputation","description":"Anesthesia for interpelviabdominal (hindquarter) amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25915","name":"Amputation of forearm","description":"Krukenberg procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23700","name":"Mnpj anes sho jt fixj aprats","description":"Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47712","name":"Excision of bile duct tumor","description":"Excision of bile duct tumor, with or without primary repair of bile duct; intrahepatic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1678.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85302","name":"Clot inhibit prot c antigen","description":"Clotting inhibitors or anticoagulants; protein c, antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0455","name":"Pump uninterrupted infusion","description":"Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58940","name":"Removal of ovary(s)","description":"Oophorectomy, partial or total, unilateral or bilateral;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":349.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74283","name":"Ther nma rdctj intus/obstrcj","description":"Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium ileus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69205","name":"Clear outer ear canal","description":"Removal foreign body from external auditory canal; with general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20822","name":"Replantation digit complete","description":"Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22110","name":"Remove part of neck vertebra","description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":918.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26720","name":"Treat finger fracture each","description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7526","name":"Tracheostomy tube collar","description":"Tracheostomy tube collar/holder, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43313","name":"Esophagoplasty congenital","description":"Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; without repair of congenital tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2265.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63615","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1114.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49084","name":"Peritoneal lavage","description":"Peritoneal lavage, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87426","name":"Sarscov coronavirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, sars-cov, s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4232","name":"Syringe w/needle insulin 3cc","description":"Syringe with needle for external insulin pump, sterile, 3 cc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00836","name":"Anes hrna rpr<37wk brth<50","description":"Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants younger than 37 weeks gestational age at birth and younger than 50 weeks gestational age at time of surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86357","name":"Nk cells total count","description":"Natural killer (nk) cells, total count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95904","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84830","name":"Ovulation tests","description":"Ovulation tests, by visual color comparison methods for human luteinizing hormone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"Q4099","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27503","name":"Treatment of thigh fracture","description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94010","name":"Breathing capacity test","description":"Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82157","name":"Assay of androstenedione","description":"Androstenedione","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2381","name":"Pneum drive wheel tire","description":"Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88104","name":"Cytopath fl nongyn smears","description":"Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5590","name":"Prep ak ischial laminated","description":"Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27254","name":"Treat hip dislocation","description":"Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1079.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2780","name":"Oversize lens/es","description":"Oversize lens, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22847","name":"Insert spine fixation device","description":"Anterior instrumentation; 8 or more vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0171T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":555.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54344","name":"Rrp hypspad comp moblj&urtp","description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); requiring mobilization of skin flaps and urethroplasty with flap or patch graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33735","name":"Revision of heart chamber","description":"Atrial septectomy or septostomy; closed heart (blalock-hanlon type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23450","name":"Repair shoulder capsule","description":"Capsulorrhaphy, anterior; putti-platt procedure or magnuson type operation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82554","name":"Creatine isoforms","description":"Creatine kinase (ck), (cpk); isoforms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0372","name":"Powered air mattress overlay","description":"Powered air overlay for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38700","name":"Removal of lymph nodes neck","description":"Suprahyoid lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":506.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14020","name":"Tis trnfr s/a/l 10 sq cm/<","description":"Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00882","name":"Anes maj lwr adb vsl ivc lig","description":"Anesthesia for procedures on major lower abdominal vessels; inferior vena cava ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53520","name":"Repair of urethra defect","description":"Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43753","name":"Tx gastro intub w/asp","description":"Gastric intubation and aspiration(s) therapeutic, necessitating physicians skill (eg, for gastrointestinal hemorrhage), including lavage if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95930","name":"Visual ep test cns w/i&r","description":"Visual evoked potential (vep) checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36680","name":"Insert needle bone cavity","description":"Placement of needle for intraosseous infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17266","name":"Dstrj mal les t/a/l >4.0 cm","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31591","name":"Laryngoplasty medialization","description":"Laryngoplasty, medialization, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":807.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75891","name":"Vein x-ray liver","description":"Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49491","name":"Rpr hern preemie reduc","description":"Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62142","name":"Rmvl b1 flp/prostc plate skl","description":"Removal of bone flap or prosthetic plate of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9603","name":"One-way allow prorated miles","description":"Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0694","name":"Uvl md cabinet sys 6 ft","description":"Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2628","name":"Fabrication & fitting","description":"Fabrication and fitting of ocular conformer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93532","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2321.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42420","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":923.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2035","name":"Kafo plastic pediatric size","description":"Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33863","name":"Ascending aortic graft","description":"Ascending aorta graft, with cardiopulmonary bypass, with aortic root replacement using valved conduit and coronary reconstruction (eg, bentall)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2749.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27059","name":"Resect hip/pelv tum 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of pelvis and hip area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86308","name":"Heterophile antibody screen","description":"Heterophile antibodies; screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35539","name":"Art byp grft aortofemoral","description":"Bypass graft, with vein; aortofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1942.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3460","name":"Shoe heel new rubber standar","description":"Heel, new rubber, standard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32701","name":"Thorax stereo rad targetw/tx","description":"Thoracic target(s) delineation for stereotactic body radiation therapy (srs/sbrt), (photon or particle beam), entire course of treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92082","name":"Intermediate visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on goldmann perimeter, or semiquantitative, automated suprathreshold screening program, humphrey suprathreshold automatic diagnostic test, octopus program 33)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50125","name":"Pyelotomy w/drg pyelostomy","description":"Pyelotomy; with drainage, pyelostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":793.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58275","name":"Hysterectomy/revise vagina","description":"Vaginal hysterectomy, with total or partial vaginectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87590","name":"N.gonorrhoeae dna dir prob","description":"Infectious agent detection by nucleic acid (dna or rna); neisseria gonorrhoeae, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35251","name":"Rpr blvsl vn grf intra-abdl","description":"Repair blood vessel with vein graft; intra-abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0978","name":"W/c acc,saf belt pelv strap","description":"Wheelchair accessory, positioning belt/safety belt/pelvic strap, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36455","name":"Bld exchange truj oth thn nb","description":"Exchange transfusion, blood; other than newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0013A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28465","name":"Optx tarsal bone fx each","description":"Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92526","name":"Oral function therapy","description":"Treatment of swallowing dysfunction and/or oral function for feeding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85576","name":"Blood platelet aggregation","description":"Platelet, aggregation (in vitro), each agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6235","name":"Hydrocolld drg >16<=48 w/o b","description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92502","name":"Ear and throat examination","description":"Otolaryngologic examination under general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41015","name":"Drainage of mouth lesion","description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93288","name":"Interrog evl pm/ldls pm ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41019","name":"Place needles h&n for rt","description":"Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0561T","name":"Antmc guide 3d print 1st gd","description":"Anatomic guide 3d-printed and designed from image data set(s); first anatomic guide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45335","name":"Sigmoidoscopy w/submuc inj","description":"Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69440","name":"Exploration of middle ear","description":"Middle ear exploration through postauricular or ear canal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4331","name":"Extension drainage tubing","description":"Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61796","name":"Srs cranial lesion simple","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93770","name":"Determination venous press","description":"Determination of venous pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47533","name":"Plmt biliary drainage cath","description":"Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":965.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67882","name":"Revision of eyelid","description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21198","name":"Reconstr lwr jaw segment","description":"Osteotomy, mandible, segmental;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44010","name":"Incision of small bowel","description":"Duodenotomy, for exploration, biopsy(s), or foreign body removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":696.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24655","name":"Cltx rdl head/nck fx w/mnpj","description":"Closed treatment of radial head or neck fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81001","name":"Urinalysis auto w/scope","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","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6237","name":"Hydrocolld drg <=16 in w/bdr","description":"Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90963","name":"Esrd home pt serv p mo <2yrs","description":"End-stage renal disease (esrd) related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0852","name":"Pwc gp 3 vhd seat/back","description":"Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15935","name":"Exc sac pr ulc skn flp ostc","description":"Excision, sacral pressure ulcer, with skin flap closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40805","name":"Removal foreign body mouth","description":"Removal of embedded foreign body, vestibule of mouth; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31830","name":"Revise windpipe scar","description":"Revision of tracheostomy scar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92340","name":"Fit spectacles monofocal","description":"Fitting of spectacles, except for aphakia; monofocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64616","name":"Chemodenerv musc neck dyston","description":"Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70486","name":"Ct maxillofacial w/o dye","description":"Computed tomography, maxillofacial area; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28606","name":"Treat foot dislocation","description":"Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83872","name":"Assay synovial fluid mucin","description":"Mucin, synovial fluid (ropes test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45397","name":"Lap remove rectum w/pouch","description":"Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, j-pouch), with diverting enterostomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1699.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2385","name":"Straight knee joint heavy du","description":"Addition to lower extremity, straight knee joint, heavy duty, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2001","name":"Post d/c h vst new pt 20 m","description":"Brief (20 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50650","name":"Removal of ureter","description":"Ureterectomy, with bladder cuff (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":844.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21461","name":"Optx mndblr fx wo ntrdntl","description":"Open treatment of mandibular fracture; without interdental fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1634.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15273","name":"Skin sub grft t/arm/lg child","description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27420","name":"Revision of unstable kneecap","description":"Reconstruction of dislocating patella; (eg, hauser type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45113","name":"Partial proctectomy","description":"Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (s or j), with or without loop ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96415","name":"Chemo iv infusion addl hr","description":"Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1085","name":"Outrigger bil w/ vert extens","description":"Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5595","name":"Hip disartic sach thermopls","description":"Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4213","name":"20+ cc syringe only","description":"Syringe, sterile, 20 cc or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00846","name":"Anes iper px rad hystrectomy","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; radical hysterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2415","name":"Knee joint cam lock each joi","description":"Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6665","name":"Teflon or equal cable lining","description":"Upper extremity addition, teflon, or equal, cable lining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42815","name":"Excision of neck cyst","description":"Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":424.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87274","name":"Herpes simplex 1 ag if","description":"Infectious agent antigen detection by immunofluorescent technique; herpes simplex virus type 1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38542","name":"Explore deep node(s) neck","description":"Dissection, deep jugular node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59076","name":"Fetal shunt placement w/us","description":"Fetal shunt placement, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23020","name":"Capsular contracture release","description":"Capsular contracture release (eg, sever type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27427","name":"Reconstruction knee","description":"Ligamentous reconstruction (augmentation), knee; extra-articular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":598.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0305","name":"Rails bed side half length","description":"Bed side rails, half length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90474","name":"Immune admin oral/nasal addl","description":"Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67961","name":"Revision of eyelid","description":"Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52270","name":"Cystoscopy & revise urethra","description":"Cystourethroscopy, with internal urethrotomy; female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88273","name":"Cytogenetics 10-30","description":"Molecular cytogenetics; chromosomal in situ hybridization, analyze 10-30 cells (eg, for microdeletions)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77290","name":"Ther rad simulaj field cplx","description":"Therapeutic radiology simulation-aided field setting; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28890","name":"Hi enrgy eswt plantar fascia","description":"Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26034","name":"Treat hand bone lesion","description":"Incision, bone cortex, hand or finger (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66720","name":"Destruction ciliary body","description":"Ciliary body destruction; cryotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7006","name":"Filtered nebulizer admin set","description":"Administration set, with small volume filtered pneumatic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10081","name":"I&d pilonidal cyst comp","description":"Incision and drainage of pilonidal cyst; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66020","name":"Injection treatment of eye","description":"Injection, anterior chamber of eye (separate procedure); air or liquid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59409","name":"Obstetrical care","description":"Vaginal delivery only (with or without episiotomy and/or forceps);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40806","name":"Incision of lip fold","description":"Incision of labial frenum (frenotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76816","name":"Ob us follow-up per fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0400","name":"Home sleep test/type 4 porta","description":"Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77063","name":"Breast tomosynthesis bi","description":"Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86789","name":"West nile virus antibody","description":"Antibody; west nile virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50575","name":"Kidney endoscopy","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15934","name":"Exc sacral pr ulc skn flap","description":"Excision, sacral pressure ulcer, with skin flap closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":616.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49321","name":"Laparoscopy biopsy","description":"Laparoscopy, surgical; with biopsy (single or multiple)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36471","name":"Njx sclrsnt mlt incmptnt vn","description":"Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01842","name":"Anes art farm wrst&hnd emblc","description":"Anesthesia for procedures on arteries of forearm, wrist, and hand; embolectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0478T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2622","name":"Adj skin pro w/c cus wd<22in","description":"Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99487","name":"Cplx chrnc care 1st 60 min","description":"Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9487","name":"Remote e/m est. pt 15mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74181","name":"Mri abdomen w/o contrast","description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01472","name":"Anes rpr rpt achilles tendon","description":"Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; repair of ruptured achilles tendon, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69633","name":"Rebuild eardrum structures","description":"Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [porp], total ossicular replacement prosthesis [torp])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2376","name":"Expandable controller, repl","description":"Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70110","name":"X-ray exam of jaw 4/> views","description":"Radiologic examination, mandible; complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1000","name":"Ctlso milwauke initial model","description":"Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":945.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23660","name":"Optx acute shoulder dislc","description":"Open treatment of acute shoulder dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92507","name":"Tx sp lang voice comm indiv","description":"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0495","name":"Charger elec/combo vad, rep","description":"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2034.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35840","name":"Explore abdominal vessels","description":"Exploration for postoperative hemorrhage, thrombosis or infection; abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1044.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27365","name":"Resect femur/knee tumor","description":"Radical resection of tumor, femur or knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99476","name":"Ped crit care age 2-5 subsq","description":"Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25525","name":"Optx rdl shft fx&cltx rad/ul","description":"Open treatment of radial shaft fracture, includes internal fixation, when performed, and closed treatment of distal radioulnar joint dislocation (galeazzi fracture/ dislocation), includes percutaneous skeletal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55870","name":"Electroejaculation","description":"Electroejaculation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87337","name":"Entamoeb hist group ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; entamoeba histolytica group","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17107","name":"Dstr cut vsc prlf les10-50sq","description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27358","name":"Remove femur lesion/fixation","description":"Excision or curettage of bone cyst or benign tumor of femur; with internal fixation (list in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97110","name":"Therapeutic exercises","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73600","name":"X-ray exam of ankle","description":"Radiologic examination, ankle; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6230","name":"Gauze > 48 sq in water/salne","description":"Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27268","name":"Cltx thigh fx w/mnpj","description":"Closed treatment of femoral fracture, proximal end, head; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0912","name":"Hd trapeze bar free standing","description":"Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84255","name":"Assay of selenium","description":"Selenium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82040","name":"Assay of serum albumin","description":"Albumin; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37785","name":"Ligate/divide/excise vein","description":"Ligation, division, and/or excision of varicose vein cluster(s), 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5684","name":"Bk fork strap","description":"Addition to lower extremity, below knee, fork strap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84244","name":"Assay of renin","description":"Renin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92083","name":"Extended visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 deg, or quantitative, automated threshold perimetry, octopus program g-1, 32 or 42, hump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37238","name":"Open/perq place stent same","description":"Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1587.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1406","name":"O2/water vapor enrich w/o he","description":"Oxygen and water vapor enriching system without heated delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98925","name":"Osteopath manj 1-2 regions","description":"Osteopathic manipulative treatment (omt); 1-2 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1235","name":"Rigid ped wc adjustable","description":"Wheelchair, pediatric size, rigid, adjustable, with seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93307","name":"Tte w/o doppler complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79300","name":"Nuclr rx interstit colloid","description":"Radiopharmaceutical therapy, by interstitial radioactive colloid administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0848","name":"Pwc gp 3 std seat/back","description":"Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45385","name":"Colonoscopy w/lesion removal","description":"Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33305","name":"Repair of heart wound","description":"Repair of cardiac wound; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3585.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6350","name":"Thoracic intern lock elbow","description":"Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2591.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51500","name":"Removal of bladder cyst","description":"Excision of urachal cyst or sinus, with or without umbilical hernia repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26479","name":"Shortening of hand tendon","description":"Shortening of tendon, flexor, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78258","name":"Esophageal motility","description":"Esophageal motility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82965","name":"Assay of gdh enzyme","description":"Glutamate dehydrogenase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93321","name":"Doppler echo f-up/lmtd std","description":"Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); follow-up or limited study (list separately in addition to codes for echocardiographic imaging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7523","name":"Tracheostomy shower protect","description":"Tracheostomy shower protector, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52260","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44157","name":"Colectomy w/ileoanal anast","description":"Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24640","name":"Cltx rdl head sublxtj nrsemd","description":"Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46258","name":"Remove in/ex hem grp w/fistu","description":"Hemorrhoidectomy, internal and external, single column/group; with fistulectomy, including fissurectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44366","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93288","name":"Interrog evl pm/ldls pm ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44406","name":"Colonoscopy w/ultrasound","description":"Colonoscopy through stoma; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0629","name":"Seat lift mech, non-electric","description":"Seat lift mechanism, non-electric, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76350","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37181","name":"Splice spleen/kidney veins","description":"Venous anastomosis, open; splenorenal, distal (selective decompression of esophagogastric varices, any technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0269","name":"Occlusive device in vein art","description":"Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28288","name":"Partial removal of foot bone","description":"Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82382","name":"Assay urine catecholamines","description":"Catecholamines; total urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99349","name":"Home/res vst est mod mdm 40","description":"Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 40 minutes must be met or excee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25248","name":"Remove forearm foreign body","description":"Exploration with removal of deep foreign body, forearm or wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":349.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86367","name":"Stem cells total count","description":"Stem cells (ie, cd34), total count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85060","name":"Blood smear interpretation","description":"Blood smear, peripheral, interpretation by physician with written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82735","name":"Assay of fluoride","description":"Fluoride","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89230","name":"Collect sweat for test","description":"Sweat collection by iontophoresis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77336","name":"Radiation physics consult","description":"Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82705","name":"Fats/lipids feces qual","description":"Fat or lipids, feces; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6883","name":"Replc sockt below e/w disa","description":"Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97542","name":"Wheelchair mngment training","description":"Wheelchair management (eg, assessment, fitting, training), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33979","name":"Insert intracorporeal device","description":"Insertion of ventricular assist device, implantable intracorporeal, single ventricle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1700.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99382","name":"Init pm e/m new pat 1-4 yrs","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74251","name":"X-ray xm sm int 2cntrst std","description":"Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66172","name":"Incision of eye","description":"Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":859.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68720","name":"Create tear sac drain","description":"Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75600","name":"Contrast exam thoracic aorta","description":"Aortography, thoracic, without serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4415","name":"Ost skn barr w/o conv >4 sqi","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5637","name":"Below knee total contact","description":"Addition to lower extremity, below knee, total contact","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83518","name":"Immunoassay dipstick","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, single step method (eg, reagent strip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92071","name":"Contact lens fitting for tx","description":"Fitting of contact lens for treatment of ocular surface disease","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16036","name":"Escharotomy ea addl incision","description":"Escharotomy; each additional incision (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88304","name":"Tissue exam by pathologist","description":"Level iii - surgical pathology, gross and microscopic examination abortion, induced abscess aneurysm - arterial/ventricular anus, tag appendix, other than incidental artery, atheromatous plaque bartholins gland cyst bone fragment(s), other than pathologic fracture bursa/synovial cyst carpal tunnel t","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70210","name":"X-ray exam of sinuses","description":"Radiologic examination, sinuses, paranasal, less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80170","name":"Assay of gentamicin","description":"Gentamicin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15772","name":"Grfg autol fat lipo ea addl","description":"Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33990","name":"Insj perq vad l hrt arterial","description":"Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58805","name":"Drainage of ovarian cyst(s)","description":"Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91112","name":"Gi wireless capsule measure","description":"Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28555","name":"Repair foot dislocation","description":"Open treatment of tarsal bone dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":702.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65430","name":"Corneal smear","description":"Scraping of cornea, diagnostic, for smear and/or culture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10160","name":"Pnxr aspir absc hmtma bulla","description":"Puncture aspiration of abscess, hematoma, bulla, or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0279","name":"Tomosynthesis, mammo","description":"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87329","name":"Giardia ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; giardia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64892","name":"Nrv grf 1strnd arm/leg <4cm","description":"Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59610","name":"Vbac delivery","description":"Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1974.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96573","name":"Pdt dstr prmlg les phys/qhp","description":"Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27227","name":"Treat hip fracture(s)","description":"Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1403.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44346","name":"Revision of colostomy","description":"Revision of colostomy; with repair of paracolostomy hernia (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44015","name":"Insert needle cath bowel","description":"Tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84210","name":"Assay of pyruvate","description":"Pyruvate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86695","name":"Herpes simplex type 1 test","description":"Antibody; herpes simplex, type 1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37785","name":"Ligate/divide/excise vein","description":"Ligation, division, and/or excision of varicose vein cluster(s), 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0339","name":"Robot lin-radsurg com, first","description":"Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2583.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95706","name":"Eeg wo vid 2-12hr intmt mntr","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, 2-12 hours; with intermittent monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80418","name":"Pituitary evaluation panel","description":"Combined rapid anterior pituitary evaluation panel this panel must include the following: adrenocorticotropic hormone (acth) (82024 x 4) luteinizing hormone (lh) (83002 x 4) follicle stimulating hormone (fsh) (83001 x 4) prolactin (84146 x 4) human growth hormone (hgh) (83003 x 4) cortisol (82533 x ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":321.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7367","name":"Replacemnt lithium ionbatter","description":"Lithium ion battery, rechargeable, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8511","name":"Indwelling trach insert","description":"Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99364","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81414","name":"Car ion chnnlpath inc 2 gns","description":"Cardiac ion channelopathies (eg, brugada syndrome, long qt syndrome, short qt syndrome, catecholaminergic polymorphic ventricular tachycardia); duplication/deletion gene analysis panel, must include analysis of at least 2 genes, including kcnh2 and kcnq1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61875","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":683.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81167","name":"Brca2 gene full dup/del alys","description":"Brca2 (brca2, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25924","name":"Amputation follow-up surgery","description":"Disarticulation through wrist; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40701","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; primary bilateral, 1-stage procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23650","name":"Cltx sho dslc w/mnpj wo anes","description":"Closed treatment of shoulder dislocation, with manipulation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38555","name":"Removal neck/armpit lesion","description":"Excision of cystic hygroma, axillary or cervical; with deep neurovascular dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":682.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46700","name":"Repair of anal stricture","description":"Anoplasty, plastic operation for stricture; adult","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75992","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41112","name":"Excision of tongue lesion","description":"Excision of lesion of tongue with closure; anterior two-thirds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":257.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38208","name":"Thaw preserved stem cells","description":"Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41830","name":"Removal of gum tissue","description":"Alveolectomy, including curettage of osteitis or sequestrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6011","name":"Collagen gel/paste wound fil","description":"Collagen based wound filler, gel/paste, per gram of collagen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97761","name":"Prosthetic traing 1st enc","description":"Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15733","name":"Musc myoq/fscq flp h&n pedcl","description":"Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86162","name":"Complement total (ch50)","description":"Complement; total hemolytic (ch50)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0194","name":"Air fluidized bed","description":"Air fluidized bed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34510","name":"Transposition of vein valve","description":"Venous valve transposition, any vein donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0435","name":"Oral hiv-1/hiv-2 screen","description":"Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72157","name":"Mri chest spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77620","name":"Hyperthermia gen intrcv prb","description":"Hyperthermia generated by intracavitary probe(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":497.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27400","name":"Revise thigh muscles/tendons","description":"Transfer, tendon or muscle, hamstrings to femur (eg, eggers type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58954","name":"Tah rad debulk/lymph remove","description":"Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90901","name":"Biofeedback train any meth","description":"Biofeedback training by any modality","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42835","name":"Removal of adenoids","description":"Adenoidectomy, secondary; younger than age 12","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8631","name":"Mcp joint repl 2 pc or more","description":"Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43130","name":"Removal of esophagus pouch","description":"Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":626.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78813","name":"Pet image full body","description":"Positron emission tomography (pet) imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1207.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0824","name":"Pwc gp 2 hd seat/back","description":"Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35638","name":"Bpg aortobi-iliac","description":"Bypass graft, with other than vein; aortobi-iliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56805","name":"Clitoroplasty intersex state","description":"Clitoroplasty for intersex state","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90785","name":"Psytx complex interactive","description":"Interactive complexity (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63610","name":"Stimulation of spinal cord","description":"Stereotactic stimulation of spinal cord, percutaneous, separate procedure not followed by other surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31531","name":"Laryngoscopy w/fb & op scope","description":"Laryngoscopy, direct, operative, with foreign body removal; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20665","name":"Rmvl tongs/halo anthr indiv","description":"Removal of tongs or halo applied by another individual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63101","name":"Remove vert body dcmprn thrc","description":"Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic, single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5673","name":"Socket insert w lock mech","description":"Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01482","name":"Anes opn lwr l/a/f rad rescj","description":"Anesthesia for open procedures on bones of lower leg, ankle, and foot; radical resection (including below knee amputation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11005","name":"Dbrdmt skin abdominal wall","description":"Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1014","name":"Reclining back add ped w/c","description":"Reclining back, addition to pediatric size wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42507","name":"Parotid duct diversion","description":"Parotid duct diversion, bilateral (wilke type procedure);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0807","name":"Pov group 2 hd 301-450 lbs","description":"Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00566","name":"Anes direct cabg w/o pump","description":"Anesthesia for direct coronary artery bypass grafting; without pump oxygenator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27330","name":"Biopsy knee joint lining","description":"Arthrotomy, knee; with synovial biopsy only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0301","name":"Hd hosp bed, 350-600 lbs","description":"Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35276","name":"Rpr blvs gr ot/t vn ntrth wo","description":"Repair blood vessel with graft other than vein; intrathoracic, without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1262.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70542","name":"Mri orbit/face/neck w/dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42825","name":"Removal of tonsils","description":"Tonsillectomy, primary or secondary; younger than age 12","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4383","name":"Urinary rubber pouch w/o fp","description":"Ostomy pouch, urinary, for use on faceplate, rubber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86940","name":"Hemolysins/agglutinins auto","description":"Hemolysins and agglutinins; auto, screen, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86784","name":"Trichinella antibody","description":"Antibody; trichinella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43647","name":"Lap impl electrode antrum","description":"Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":689.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01742","name":"Anes opn/arthrs elbw osteot","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; osteotomy of humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26113","name":"Exc hand tum deep 1.5 cm/>","description":"Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); 1.5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64892","name":"Nrv grf 1strnd arm/leg <4cm","description":"Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":890.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8612","name":"Aqueous shunt prosthesis","description":"Aqueous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":328.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99238","name":"Hosp ip/obs dschrg mgmt 30/<","description":"Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90460","name":"Im admin 1st/only component","description":"Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51798","name":"Us urine capacity measure","description":"Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79440","name":"Nuclear rx intra-articular","description":"Radiopharmaceutical therapy, by intra-articular administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0041","name":"Large size footplate each","description":"Large size footplate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52224","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of minor (less than 0.5 cm) lesion(s) with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92545","name":"Oscillating tracking test","description":"Oscillating tracking test, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4234","name":"J-cell batt for glucose mon","description":"Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57105","name":"Biopsy vaginal mucosa xtnsv","description":"Biopsy of vaginal mucosa; extensive, requiring suture (including cysts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33612","name":"Repair double ventricle","description":"Repair of double outlet right ventricle with intraventricular tunnel repair; with repair of right ventricular outflow tract obstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1743.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54437","name":"Repair corporeal tear","description":"Repair of traumatic corporeal tear(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3976","name":"Sewhfo airplane w/o jnts cf","description":"Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5962","name":"Below knee flex cover system","description":"Addition, endoskeletal system, below knee, flexible protective outer surface covering system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57335","name":"Repair vagina","description":"Vaginoplasty for intersex state","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99423","name":"Ol dig e/m svc 21+ min","description":"Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93312","name":"Echo transesophageal","description":"Echocardiography, transesophageal, real-time with image documentation (2d) (with or without m-mode recording); including probe placement, image acquisition, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87205","name":"Smear gram stain","description":"Smear, primary source with interpretation; gram or giemsa stain for bacteria, fungi, or cell types","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6632","name":"Latex suspension sleeve each","description":"Upper extremity addition, latex suspension sleeve, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92583","name":"Select picture audiometry","description":"Select picture audiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34813","name":"Femoral endovas graft add-on","description":"Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0433","name":"Elisa hiv-1/hiv-2 screen","description":"Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12015","name":"Rpr f/e/e/n/l/m 7.6-12.5 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33243","name":"Remove eltrd/thoracotomy","description":"Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1185.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59430","name":"Care after delivery","description":"Postpartum care only (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96360","name":"Hydration iv infusion init","description":"Intravenous infusion, hydration; initial, 31 minutes to 1 hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44187","name":"Lap ileo/jejuno-stomy","description":"Laparoscopy, surgical; ileostomy or jejunostomy, non-tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":885.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","name":"Comprehen metabolic panel","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) potassium (84132) protein, total (84155) sodium ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86343","name":"Leukocyte histamine release","description":"Leukocyte histamine release test (lhr)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6448","name":"Lt compres band <3in/yd","description":"Light compression bandage, elastic, knitted/woven, width less than three inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76886","name":"Us exam infant hips static","description":"Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80160","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77055","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44125","name":"Removal of small intestine","description":"Enterectomy, resection of small intestine; with enterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33212","name":"Insert pulse gen sngl lead","description":"Insertion of pacemaker pulse generator only; with existing single lead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48105","name":"Resect/debride pancreas","description":"Resection or debridement of pancreas and peripancreatic tissue for acute necrotizing pancreatitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2356.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7403","name":"Add ue prost b/e acrylic","description":"Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84210","name":"Assay of pyruvate","description":"Pyruvate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64766","name":"Incise hip/thigh nerve","description":"Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93279","name":"Prgrmg dev eval pm/ldls pm","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0507T","name":"Near ifr 2img mibmn glnd i&r","description":"Near infrared dual imaging (ie, simultaneous reflective and transilluminated light) of meibomian glands, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86486","name":"Skin test unlisted antign ea","description":"Skin test; unlisted antigen, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21047","name":"Excise lwr jaw cyst w/repair","description":"Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1029.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6544","name":"Gc stocking garter belt","description":"Gradient compression stocking, garter belt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13133","name":"Cmplx rpr f/c/c/m/n/ax/g/h/f","description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27520","name":"Treat kneecap fracture","description":"Closed treatment of patellar fracture, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44151","name":"Removal of colon/ileostomy","description":"Colectomy, total, abdominal, without proctectomy; with continent ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1807.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13152","name":"Cmplx rpr e/n/e/l 2.6-7.5 cm","description":"Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86618","name":"Lyme disease antibody","description":"Antibody; borrelia burgdorferi (lyme disease)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0302","name":"Ex hd hosp bed > 600 lbs","description":"Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45190","name":"Destruction rectal tumor","description":"Destruction of rectal tumor (eg, electrodesiccation, electrosurgery, laser ablation, laser resection, cryosurgery) transanal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":552.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92978","name":"Endoluminl ivus oct c 1st","description":"Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (list separately in addition to code for p","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97804","name":"Medical nutrition group","description":"Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35281","name":"Rpr blvsl gr ot/th vn ntr-ab","description":"Repair blood vessel with graft other than vein; intra-abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86701","name":"Hiv-1antibody","description":"Antibody; hiv-1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31636","name":"Bronchoscopy bronch stents","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4154","name":"Ef spec metabolic noninherit","description":"Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12020","name":"Tx supfc wnd dehsn smpl clsr","description":"Treatment of superficial wound dehiscence; simple closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64823","name":"Sympathectomy supfc palmar","description":"Sympathectomy; superficial palmar arch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3766","name":"Ewhfo w/joint(s) cf","description":"Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81003","name":"Urinalysis auto w/o scope","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, without microscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47125","name":"Partial removal of liver","description":"Hepatectomy, resection of liver; total left lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92584","name":"Electrocochleography","description":"Electrocochleography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11310","name":"Shave skin lesion 0.5 cm/<","description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53850","name":"Prostatic microwave thermotx","description":"Transurethral destruction of prostate tissue; by microwave thermotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49555","name":"Rerepair fem hernia reduce","description":"Repair recurrent femoral hernia; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86632","name":"Chlamydia igm antibody","description":"Antibody; chlamydia, igm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64483","name":"Njx aa&/strd tfrm epi l/s 1","description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or ct), lumbar or sacral, single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00750","name":"Anes hrna rpr upr abd nos","description":"Anesthesia for hernia repairs in upper abdomen; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80074","name":"Acute hepatitis panel","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)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87804","name":"Influenza assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; influenza","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83876","name":"Assay myeloperoxidase","description":"Myeloperoxidase (mpo)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54660","name":"Revision of testis","description":"Insertion of testicular prosthesis (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0397","name":"Alcohol/subs interv >30 min","description":"Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68816","name":"Probe nl duct w/balloon","description":"Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":484.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28100","name":"Removal of ankle/heel lesion","description":"Excision or curettage of bone cyst or benign tumor, talus or calcaneus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2770","name":"Occluder lens/es","description":"Occluder lens, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77771","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":474.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55605","name":"Vesiculotomy complicated","description":"Vesiculotomy; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":422.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45563","name":"Exploration/repair of rectum","description":"Exploration, repair, and presacral drainage for rectal injury; with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1385.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63045","name":"Lam facetec & foramot crv","description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57465","name":"Cam cervix uteri drg colp","description":"Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53447","name":"Remove/replace ur sphincter","description":"Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80076","name":"Hepatic function panel","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 amino (ast) (sgot) (84450)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1280","name":"Rib gusset (elastic) each","description":"Addition to tlso, (low profile), rib gusset (elastic), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5702","name":"Replace socket hip","description":"Replacement, socket, hip disarticulation, including hip joint, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29015","name":"Appl rissr jacket bdy w/head","description":"Application of risser jacket, localizer, body; including head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70100","name":"X-ray exam of jaw <4views","description":"Radiologic examination, mandible; partial, less than 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2386","name":"Foam filled drive wheel tire","description":"Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33750","name":"Shunt subclavian to pulm art","description":"Shunt; subclavian to pulmonary artery (blalock-taussig type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26125","name":"Release palm contracture","description":"Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft); each additional digit (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93616","name":"Esophageal recording w/pacg","description":"Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34843","name":"Endovasc visc aorta 3 graft","description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1394.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86317","name":"Immunoassay infectious agent","description":"Immunoassay for infectious agent antibody, quantitative, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94070","name":"Evaluation of wheezing","description":"Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9276","name":"Disposable sensor, cgm sys","description":"Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11442","name":"Exc face-mm b9+marg 1.1-2 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73223","name":"Mri joint upr extr w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65450","name":"Treatment of corneal lesion","description":"Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15278","name":"Skn sub grft f/n/hf/g ch add","description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62147","name":"Crnop w/autograft>5 cm diam","description":"Cranioplasty with autograft (includes obtaining bone grafts); larger than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0552T","name":"Low-level laser therapy","description":"Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49611","name":"Repair umbilical lesion","description":"Repair of omphalocele (gross type operation); second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7509","name":"Heat & moisture exchange sys","description":"Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85445","name":"Heinz bodies induced","description":"Heinz bodies; induced, acetyl phenylhydrazine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34001","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8185","name":"Flutter device","description":"Flutter device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86225","name":"Dna antibody native","description":"Deoxyribonucleic acid (dna) antibody; native or double stranded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47425","name":"Incision of bile duct","description":"Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; with transduodenal sphincterotomy or sphincteroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1145.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27604","name":"Drain lower leg bursa","description":"Incision and drainage, leg or ankle; infected bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30540","name":"Rpr choanal atresia ntranasl","description":"Repair choanal atresia; intranasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96936","name":"Rcm i&r only ea addl lesion","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; interpretation and report only, each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92325","name":"Modification of contact lens","description":"Modification of contact lens (separate procedure), with medical supervision of adaptation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50230","name":"Removal kidney open radical","description":"Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0739","name":"Repair/svc dme non-oxygen eq","description":"Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33997","name":"Rmvl perq right heart vad","description":"Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2376","name":"Expandable controller, repl","description":"Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93971","name":"Extremity study","description":"Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38724","name":"Removal of lymph nodes neck","description":"Cervical lymphadenectomy (modified radical neck dissection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":912.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0487","name":"Leads any type vad, rep only","description":"Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73200","name":"Ct upper extremity w/o dye","description":"Computed tomography, upper extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28022","name":"Exploration of foot joint","description":"Arthrotomy, including exploration, drainage, or removal of loose or foreign body; metatarsophalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":395.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17108","name":"Dstr cut vsc prlf les>50sqcm","description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80201","name":"Assay of topiramate","description":"Topiramate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29828","name":"Sho arthrs srg bicp tenodsis","description":"Arthroscopy, shoulder, surgical; biceps tenodesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":774.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96375","name":"Tx/pro/dx inj new drug addon","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31725","name":"Clearance of airways","description":"Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedside","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67900","name":"Repair brow defect","description":"Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99395","name":"Prev visit est age 18-39","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0272","name":"Mattress foam rubber","description":"Mattress, foam rubber","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29010","name":"Appl risser jacket body only","description":"Application of risser jacket, localizer, body; only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":220.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4280","name":"Brst prsths adhsv attchmnt","description":"Adhesive skin support attachment for use with external breast prosthesis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82820","name":"Hemoglobin-oxygen affinity","description":"Hemoglobin-oxygen affinity (po2 for 50% hemoglobin saturation with oxygen)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88302","name":"Tissue exam by pathologist","description":"Level ii - surgical pathology, gross and microscopic examination appendix, incidental fallopian tube, sterilization fingers/toes, amputation, traumatic foreskin, newborn hernia sac, any location hydrocele sac nerve skin, plastic repair sympathetic ganglion testis, castration vaginal mucosa, incident","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25135","name":"Remove & graft wrist lesion","description":"Excision or curettage of bone cyst or benign tumor of carpal bones; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":470.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69530","name":"Extensive mastoid surgery","description":"Petrous apicectomy including radical mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50600","name":"Exploration of ureter","description":"Ureterotomy with exploration or drainage (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":759.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69550","name":"Exc aurl glomus tum trnscanl","description":"Excision aural glomus tumor; transcanal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36245","name":"Ins cath abd/l-ext art 1st","description":"Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1091.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33775","name":"Rpr tga atr bfl rmvl plm bnd","description":"Repair of transposition of the great arteries, atrial baffle procedure (eg, mustard or senning type) with cardiopulmonary bypass; with removal of pulmonary band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1609.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82163","name":"Assay of angiotensin ii","description":"Angiotensin ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99384","name":"Prev visit new age 12-17","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20000","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99185","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5560","name":"Prep ak ischial plast molded","description":"Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90473","name":"Immune admin oral/nasal","description":"Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00472","name":"Anes prtl rib rescj thoracop","description":"Anesthesia for partial rib resection; thoracoplasty (any type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84432","name":"Assay of thyroglobulin","description":"Thyroglobulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82608","name":"B-12 binding capacity","description":"Cyanocobalamin (vitamin b-12); unsaturated binding capacity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6370","name":"Thoracic passive restor cap","description":"Interscapular thoracic, passive restoration (shoulder cap only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83662","name":"Foam stability fetal lung","description":"Fetal lung maturity assessment; foam stability test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92242","name":"Fluorescein&icg angiography","description":"Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":144.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61215","name":"Ins subq rsvr pmp/nfs sys","description":"Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":452.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49553","name":"Rpr fem hernia init blocked","description":"Repair initial femoral hernia, any age; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22865","name":"Rmvl tot arthrp 1ntrspc lmbr","description":"Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2064.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61450","name":"Crnec stpl sctj cmprn/dcmprn","description":"Craniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1760.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4155","name":"Ef incomplete/modular","description":"Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 un","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70220","name":"X-ray exam of sinuses","description":"Radiologic examination, sinuses, paranasal, complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72191","name":"Ct angiograph pelv w/o&w/dye","description":"Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53230","name":"Removal of urethra lesion","description":"Excision of urethral diverticulum (separate procedure); female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86638","name":"Q fever antibody","description":"Antibody; coxiella burnetii (q fever)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87140","name":"Culture type immunofluoresc","description":"Culture, typing; immunofluorescent method, each antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0265","name":"Hosp bed total electr w/ mat","description":"Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66130","name":"Remove eye lesion","description":"Excision of lesion, sclera","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":425.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26568","name":"Lengthen metacarpal/finger","description":"Osteoplasty, lengthening, metacarpal or phalanx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":760.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64821","name":"Sympathectomy radial artery","description":"Sympathectomy; radial artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67039","name":"Laser treatment of retina","description":"Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":577.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3500","name":"Ortho shoe add leather insol","description":"Orthopedic shoe addition, insole, leather","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75898","name":"Follow-up angiography","description":"Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15121","name":"Splt agrft f/s/n/h/f/g/m ea","description":"Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92975","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":402.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48148","name":"Removal of pancreatic duct","description":"Excision of ampulla of vater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1046.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1280","name":"Rib gusset (elastic) each","description":"Addition to tlso, (low profile), rib gusset (elastic), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62121","name":"Incise skull repair","description":"Craniotomy for repair of encephalocele, skull base","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1338.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95145","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83805","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23182","name":"Prtl excision bone scapula","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), scapula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27566","name":"Treat kneecap dislocation","description":"Open treatment of patellar dislocation, with or without partial or total patellectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27894","name":"Decompression of leg","description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21154","name":"Rcnstj mdfc lefort iii w/o i","description":"Reconstruction midface, lefort iii (extracranial), any type, requiring bone grafts (includes obtaining autografts); without lefort i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1592.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81344","name":"Tbp gene detc abnor alleles","description":"Tbp (tata box binding protein) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19296","name":"Place po breast cath for rad","description":"Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33418","name":"Repair tcat mitral valve","description":"Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82128","name":"Amino acids mult qual","description":"Amino acids; multiple, qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46261","name":"Remove in/ex hem grps & fiss","description":"Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83018","name":"Heavy metal quan each nes","description":"Heavy metal (eg, antimony, arsenic, barium, beryllium, bismuth, gadolinium, mercury); quantitative, each, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44361","name":"Small bowel endoscopy/biopsy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70170","name":"X-ray exam of tear duct","description":"Dacryocystography, nasolacrimal duct, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4860","name":"Disposable catheter tips","description":"Disposable catheter tips for peritoneal dialysis, per 10","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84203","name":"Test rbc protoporphyrin","description":"Protoporphyrin, rbc; screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4495","name":"Thigh length surg stocking","description":"Surgical stockings thigh length, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0041","name":"Large size footplate each","description":"Large size footplate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43238","name":"Egd us fine needle bx/aspir","description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23395","name":"Muscle transfer shoulder/arm","description":"Muscle transfer, any type, shoulder or upper arm; single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36557","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":907.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28090","name":"Removal of foot lesion","description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15101","name":"Splt agrft t/a/l ea addl 100","description":"Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58825","name":"Transposition ovary(s)","description":"Transposition, ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0560T","name":"Antmc mdl 3d print ea addl","description":"Anatomic model 3d-printed from image data set(s); each additional individually prepared and processed component of an anatomic structure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96202","name":"Mlt fam grp bhv train 1st 60","description":"Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of paren","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75993","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75710","name":"Artery x-rays arm/leg","description":"Angiography, extremity, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78265","name":"Gstr emptg img sm bwl trnst","description":"Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26455","name":"Incision of finger tendon","description":"Tenotomy, flexor, finger, open, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27049","name":"Resect hip/pelv tum < 5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of pelvis and hip area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57511","name":"Cryocautery of cervix","description":"Cautery of cervix; cryocautery, initial or repeat","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85097","name":"Bone marrow interpretation","description":"Bone marrow, smear interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63064","name":"Decompress spinal cord thrc","description":"Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1602.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86668","name":"Francisella tularensis","description":"Antibody; francisella tularensis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11103","name":"Tangntl bx skin ea sep/addl","description":"Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47130","name":"Partial removal of liver","description":"Hepatectomy, resection of liver; total right lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34704","name":"Evasc rpr a-unilac ndgft rpt","description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63276","name":"Bx/exc xdrl spine lesn thrc","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1623.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82595","name":"Assay of cryoglobulin","description":"Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2785","name":"Drop lock retainer each","description":"Addition to lower extremity orthosis, drop lock retainer, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44005","name":"Freeing of bowel adhesion","description":"Enterolysis (freeing of intestinal adhesion) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64490","name":"Inj paravert f jnt c/t 1 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), cervical or thoracic; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58240","name":"Removal of pelvis contents","description":"Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85044","name":"Manual reticulocyte count","description":"Blood count; reticulocyte, manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27095","name":"Injection for hip x-ray","description":"Injection procedure for hip arthrography; with anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61613","name":"Remove aneurysm sinus","description":"Obliteration of carotid aneurysm, arteriovenous malformation, or carotid-cavernous fistula by dissection within cavernous sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43274","name":"Ercp duct stent placement","description":"Endoscopic retrograde cholangiopancreatography (ercp); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":355.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60600","name":"Remove carotid body lesion","description":"Excision of carotid body tumor; without excision of carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22515","name":"Perq vertebral augmentation","description":"Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51727","name":"Cystometrogram w/up","description":"Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7014","name":"Compressor nondispos filter","description":"Filter, nondisposable, used with aerosol compressor or ultrasonic generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77086","name":"Vrt fracture assmt via dxa","description":"Vertebral fracture assessment via dual-energy x-ray absorptiometry (dxa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97750","name":"Physical performance test","description":"Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51575","name":"Removal of bladder & nodes","description":"Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27680","name":"Release of lower leg tendon","description":"Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58970","name":"Retrieval of oocyte","description":"Follicle puncture for oocyte retrieval, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37216","name":"Transcath stent cca w/o eps","description":"Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":773.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73060","name":"X-ray exam of humerus","description":"Radiologic examination; humerus, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28261","name":"Revision of foot tendon","description":"Capsulotomy, midfoot; with tendon lengthening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38222","name":"Dx bone marrow bx & aspir","description":"Diagnostic bone marrow; biopsy(ies) and aspiration(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53220","name":"Treatment of urethra lesion","description":"Excision or fulguration of carcinoma of urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33924","name":"Remove pulmonary shunt","description":"Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21263","name":"Revise eye sockets","description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42220","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate; secondary lengthening procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":468.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99412","name":"Preventive counseling group","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77086","name":"Vrt fracture assmt via dxa","description":"Vertebral fracture assessment via dual-energy x-ray absorptiometry (dxa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63278","name":"Bx/exc xdrl spine lesn scrl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1450.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37765","name":"Stab phleb veins xtr 10-20","description":"Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":228.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76932","name":"Echo guide for heart biopsy","description":"Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58611","name":"Ligate oviduct(s) add-on","description":"Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33822","name":"Repair pda div<18 years","description":"Repair of patent ductus arteriosus; by division, younger than 18 years","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33506","name":"Repair artery translocation","description":"Repair of anomalous coronary artery from pulmonary artery origin; by translocation from pulmonary artery to aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1789.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8046","name":"Partial facial prosthesis","description":"Partial facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","KM","95","93","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24650","name":"Cltx rdl head/nck fx wo mnpj","description":"Closed treatment of radial head or neck fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7027","name":"Combination oral/nasal mask","description":"Combination oral/nasal mask, used with continuous positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2530","name":"Contact lens gas impermeable","description":"Contact lens, scleral, gas impermeable, per lens (for contact lens modification, see 92325)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86256","name":"Fluorescent antibody titer","description":"Fluorescent noninfectious agent antibody; titer, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22808","name":"Arthrd ant dfrm 2-3 vrt sgm","description":"Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1614.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S4989","name":"Contracept iud","description":"Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29871","name":"Arthrs knee surg for infctj","description":"Arthroscopy, knee, surgical; for infection, lavage and drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15241","name":"Fth/gft f/c/c/m/n/a/g/h/f ea","description":"Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95874","name":"Guide nerv destr needle emg","description":"Needle electromyography for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1230","name":"Power operated vehicle","description":"Power operated vehicle (three or four wheel nonhighway) specify brand name and model number","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50060","name":"Nl removal calculus","description":"Nephrolithotomy; removal of calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78272","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15956","name":"Exc trchntr pr ulc prep flap","description":"Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":760.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2369","name":"Pwr wc drivewheel gear repl","description":"Power wheelchair component, drive wheel gear box, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4351","name":"Straight tip urine catheter","description":"Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61790","name":"Treat trigeminal nerve","description":"Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":793.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33608","name":"Repair anomaly w/conduit","description":"Repair of complex cardiac anomaly other than pulmonary atresia with ventricular septal defect by construction or replacement of conduit from right or left ventricle to pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1563.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95867","name":"Ndl emg cranial nrv musc uni","description":"Needle electromyography; cranial nerve supplied muscle(s), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0431","name":"Portable gaseous 02","description":"Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2385","name":"Straight knee joint heavy du","description":"Addition to lower extremity, straight knee joint, heavy duty, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2063","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57240","name":"Anterior colporrhaphy","description":"Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystourethroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33238","name":"Remove electrode/thoracotomy","description":"Removal of permanent transvenous electrode(s) by thoracotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":810.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86653","name":"Encephaltis st louis antbody","description":"Antibody; encephalitis, st. louis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5670","name":"Bk molded supracondylar susp","description":"Addition to lower extremity, below knee, molded supracondylar suspension (pts or similar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31591","name":"Laryngoplasty medialization","description":"Laryngoplasty, medialization, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94727","name":"Gas dil/wshot deter lng vol","description":"Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90965","name":"Esrd home pt serv p mo 12-19","description":"End-stage renal disease (esrd) related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":321.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0630","name":"Patient lift hydraulic","description":"Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78725","name":"Kidney function study","description":"Kidney function study, non-imaging radioisotopic study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31084","name":"Removal of frontal sinus","description":"Sinusotomy frontal; obliterative, with osteoplastic flap, brow incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46712","name":"Repr per/vag pouch dbl proc","description":"Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; combined transperineal and transabdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11602","name":"Exc tr-ext mal+marg 1.1-2 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9485","name":"Remote e/m new pt 60mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92651","name":"Aep hearing status deter i&r","description":"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36830","name":"Artery-vein nonautograft","description":"Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27245","name":"Treat thigh fracture","description":"Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1039.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73110","name":"X-ray exam of wrist","description":"Radiologic examination, wrist; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95709","name":"Eeg w/o vid ea 12-26hr intmt","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, each increment of 12-26 hours; with intermittent monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93505","name":"Endomyocardial biopsy","description":"Endomyocardial biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":713.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2640","name":"Pelvic control band & belt b","description":"Addition to lower extremity, pelvic control, band and belt, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73222","name":"Mri joint upr extrem w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33417","name":"Repair of aortic valve","description":"Aortoplasty (gusset) for supravalvular stenosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1446.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64595","name":"Rev/rmv prph sac/gstr npg/r","description":"Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82693","name":"Assay of ethylene glycol","description":"Ethylene glycol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90822","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21154","name":"Rcnstj mdfc lefort iii w/o i","description":"Reconstruction midface, lefort iii (extracranial), any type, requiring bone grafts (includes obtaining autografts); without lefort i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32660","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":801.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22226","name":"Osteot dsc ant 1vrt sgm ea","description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96377","name":"Applicaton on-body injector","description":"Application of on-body injector (includes cannula insertion) for timed subcutaneous injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87339","name":"H pylori ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; helicobacter pylori","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26645","name":"Treat thumb fracture","description":"Closed treatment of carpometacarpal fracture dislocation, thumb (bennett fracture), with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":359.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96416","name":"Chemo prolong infuse w/pump","description":"Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29861","name":"Hip arthro w/fb removal","description":"Arthroscopy, hip, surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01990","name":"Physiol support hrvg organs","description":"Physiological support for harvesting of organ(s) from brain-dead patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11762","name":"Reconstruction of nail bed","description":"Reconstruction of nail bed with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35221","name":"Rpr bld vsl dir intra-abdl","description":"Repair blood vessel, direct; intra-abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1284.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51797","name":"Intraabdominal pressure test","description":"Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27428","name":"Reconstruction knee","description":"Ligamentous reconstruction (augmentation), knee; intra-articular (open)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":942.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64776","name":"Remove digit nerve lesion","description":"Excision of neuroma; digital nerve, 1 or both, same digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0248T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":785.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78012","name":"Thyroid uptake measurement","description":"Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0001","name":"Standard wheelchair","description":"Standard wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77285","name":"Ther rad simulaj field intrm","description":"Therapeutic radiology simulation-aided field setting; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":372.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4160","name":"Ef ped caloric dense>/=0.7kc","description":"Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99192","name":"Special pump services","description":"Assembly and operation of pump with oxygenator or heat exchanger (with or without ecg and/or pressure monitoring); 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12016","name":"Rpr fe/e/en/l/m 12.6-20.0 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27405","name":"Repair of knee ligament","description":"Repair, primary, torn ligament and/or capsule, knee; collateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97550","name":"Caregiver traing 1st 30 min","description":"Caregiver training in strategies and techniques to facilitate the patients functional performance in the home or community (eg, activities of daily living [adls], instrumental adls [iadls], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87512","name":"Gardner vag dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); gardnerella vaginalis, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24400","name":"Osteot humerus w/wo int fixj","description":"Osteotomy, humerus, with or without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86720","name":"Leptospira antibody","description":"Antibody; leptospira","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69710","name":"Implant/replace hearing aid","description":"Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49657","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1105.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97161","name":"Pt eval low complex 20 min","description":"Physical therapy evaluation: low complexity, requiring these components: a history with no personal factors and/or comorbidities that impact the plan of care; an examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77263","name":"Ther radiology tx plng cplx","description":"Therapeutic radiology treatment planning; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50541","name":"Laparo ablate renal cyst","description":"Laparoscopy, surgical; ablation of renal cysts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92250","name":"Fundus photography w/i&r","description":"Fundus photography with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50810","name":"Fusion of ureter & bowel","description":"Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of abdominal or perineal colostomy, including intestine anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94645","name":"Cont inhlj tx each addl hour","description":"Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51720","name":"Treatment of bladder lesion","description":"Bladder instillation of anticarcinogenic agent (including retention time)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36013","name":"Place catheter in artery","description":"Introduction of catheter, right heart or main pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33020","name":"Incision of heart sac","description":"Pericardiotomy for removal of clot or foreign body (primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62000","name":"Treat skull fracture","description":"Elevation of depressed skull fracture; simple, extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":937.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27704","name":"Removal of ankle implant","description":"Removal of ankle implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":478.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33889","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":695.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92541","name":"Spontaneous nystagmus test","description":"Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49614","name":"Rpr aa hrn rcr < 3 ncr/strn","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":457.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S4989","name":"Contracept iud","description":"Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40843","name":"Reconstruction of mouth","description":"Vestibuloplasty; posterior, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":940.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20956","name":"Iliac bone graft microvasc","description":"Bone graft with microvascular anastomosis; iliac crest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43611","name":"Excision of stomach lesion","description":"Excision, local; malignant tumor of stomach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1018.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61867","name":"Implant neuroelectrode","description":"Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92284","name":"Dx dark adaptation exam i&r","description":"Diagnostic dark adaptation examination (eg, rod and cone sensitivities, rod-cone breakpoint), with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51920","name":"Close bladder-uterus fistula","description":"Closure of vesicouterine fistula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74485","name":"Dilation urtr/urt rs&i","description":"Dilation of ureter(s) or urethra, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0429","name":"Dermal filler injection(s)","description":"Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29520","name":"Strapping of hip","description":"Strapping; hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0010","name":"Admin hepatitis b vaccine","description":"Administration of hepatitis b vaccine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97803","name":"Med nutrition indiv subseq","description":"Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69950","name":"Incise inner ear nerve","description":"Vestibular nerve section, transcranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1427.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92317","name":"C-lens fitg tech corneosclrl","description":"Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneoscleral lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72082","name":"X-ray exam entire spi 2/3 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68700","name":"Repair tear ducts","description":"Plastic repair of canaliculi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43341","name":"Fuse esophagus & intestine","description":"Esophagojejunostomy (without total gastrectomy); thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1158.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88264","name":"Chromosome analysis 20-25","description":"Chromosome analysis; analyze 20-25 cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22101","name":"Remove part thorax vertebra","description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58954","name":"Tah rad debulk/lymph remove","description":"Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1381.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86146","name":"Beta-2 glycoprotein antibody","description":"Beta 2 glycoprotein i antibody, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53085","name":"Drainage of urinary leakage","description":"Drainage of perineal urinary extravasation; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":524.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95708","name":"Eeg wo vid ea 12-26hr unmntr","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, each increment of 12-26 hours; unmonitored","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01402","name":"Anes opn/arth tot kne arthrp","description":"Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87337","name":"Entamoeb hist group ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; entamoeba histolytica group","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82330","name":"Assay of calcium","description":"Calcium; ionized","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38505","name":"Needle biopsy lymph nodes","description":"Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50070","name":"Nl comp cgen kdn abnormality","description":"Nephrolithotomy; complicated by congenital kidney abnormality","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26502","name":"Hand tendon reconstruction","description":"Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5710","name":"Kne-shin exo sng axi mnl loc","description":"Addition, exoskeletal knee-shin system, single axis, manual lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67904","name":"Repair eyelid defect","description":"Repair of blepharoptosis; (tarso) levator resection or advancement, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":447.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5010","name":"Assessment for hearing aid","description":"Assessment for hearing aid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50394","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26862","name":"Fusion/graft of finger joint","description":"Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":610.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67255","name":"Reinforce/graft eye wall","description":"Scleral reinforcement (separate procedure); with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26700","name":"Treat knuckle dislocation","description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":277.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29887","name":"Arthrs knee srg drlg od fixj","description":"Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76828","name":"Echo exam of fetal heart","description":"Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31551","name":"Laryngoplasty laryngeal sten","description":"Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50327","name":"Prep renal graft/venous","description":"Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82533","name":"Total cortisol","description":"Cortisol; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44500","name":"Intro gastrointestinal tube","description":"Introduction of long gastrointestinal tube (eg, miller-abbott) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2219","name":"Foam caster tire any size ea","description":"Manual wheelchair accessory, foam caster tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29892","name":"Arthrs aid rpr od les/tib fx","description":"Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78814","name":"Pet image w/ct lmtd","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62140","name":"Crnop skull defect<5 cm diam","description":"Cranioplasty for skull defect; up to 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84228","name":"Assay of quinine","description":"Quinine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0332","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64445","name":"Njx aa&/strd sciatic nrv img","description":"Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25073","name":"Exc forearm tum deep 3 cm/>","description":"Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43847","name":"Gstr rstcv px sm int rcnstj","description":"Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1515.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67312","name":"Revise two eye muscles","description":"Strabismus surgery, recession or resection procedure; 2 horizontal muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87797","name":"Detect agent nos dna dir","description":"Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; direct probe technique, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64553","name":"Implant neuroelectrodes","description":"Percutaneous implantation of neurostimulator electrode array; cranial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1638.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27691","name":"Revise lower leg tendon","description":"Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50820","name":"Construct bowel bladder","description":"Ureteroileal conduit (ileal bladder), including intestine anastomosis (bricker operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1067.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62115","name":"Reduction of skull defect","description":"Reduction of craniomegalic skull (eg, treated hydrocephalus); not requiring bone grafts or cranioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1527.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83835","name":"Assay of metanephrines","description":"Metanephrines","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51960","name":"Revision of bladder & bowel","description":"Enterocystoplasty, including intestinal anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1120.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34151","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2006","name":"Post-d/c h vst ext pt 20 m","description":"Brief (20 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facili","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7033","name":"Replacement nasal pillows","description":"Pillow for use on nasal cannula type interface, replacement only, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34714","name":"Opn fem art expos cndt crtj","description":"Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6050","name":"Wrst mld sck flx hng tri pad","description":"Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1099.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61322","name":"Crnec/crnot dcmprv w/o lobec","description":"Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2179.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1834","name":"Ko w/0 joint rigid molded to","description":"Knee orthosis, without knee joint, rigid, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92508","name":"Tx sp lang voice comm group","description":"Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27498","name":"Decompression of thigh/knee","description":"Decompression fasciotomy, thigh and/or knee, multiple compartments;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26735","name":"Treat finger fracture each","description":"Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33860","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2703.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33988","name":"Insertion of left heart vent","description":"Insertion of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ecmo/ecls","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":678.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21175","name":"Rcnst bfrnt sp orb rm&lw fhd","description":"Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1867.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30020","name":"Drainage of nose lesion","description":"Drainage abscess or hematoma, nasal septum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27062","name":"Remove femur lesion/bursa","description":"Excision; trochanteric bursa or calcification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58958","name":"Resc recr ovr tbl pp utr mal","description":"Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed, with pelvic lymphadenectomy and limited para-aortic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70250","name":"X-ray exam of skull","description":"Radiologic examination, skull; less than 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67042","name":"Vit for macular hole","description":"Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":689.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35206","name":"Repair blood vessel dir uxtr","description":"Repair blood vessel, direct; upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74177","name":"Ct abd & pelvis w/contrast","description":"Computed tomography, abdomen and pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88307","name":"Tissue exam by pathologist","description":"Level v - surgical pathology, gross and microscopic examination adrenal, resection bone - biopsy/curettings bone fragment(s), pathologic fracture brain, biopsy brain/meninges, tumor resection breast, excision of lesion, requiring microscopic evaluation of surgical margins breast, mastectomy - partia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6722","name":"Hook/hand, hvy dty, vol clos","description":"Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":987.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33222","name":"Relocation pocket pacemaker","description":"Relocation of skin pocket for pacemaker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5500","name":"Diab shoe for density insert","description":"For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92145","name":"Corneal hysteresis deter","description":"Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6675","name":"Harness figure of 8 sing con","description":"Upper extremity addition, harness, (e.g., figure of eight type), single cable design","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25110","name":"Remove wrist tendon lesion","description":"Excision, lesion of tendon sheath, forearm and/or wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":285.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40808","name":"Biopsy of mouth lesion","description":"Biopsy, vestibule of mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41130","name":"Partial removal of tongue","description":"Glossectomy; hemiglossectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1019.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29325","name":"Appl hip spica cast1&1/2","description":"Application of hip spica cast; 1 and one-half spica or both legs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27752","name":"Treatment of tibia fracture","description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":449.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50782","name":"Reimplant ureter in bladder","description":"Ureteroneocystostomy; anastomosis of duplicated ureter to bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":869.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22315","name":"Closed tx vert fx w/manj","description":"Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":747.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15135","name":"Drm agrft f/s/n/h/f/g/m 1st","description":"Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23078","name":"Rad rescj tum shoulder 5cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1231.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59857","name":"Induced ab 1+vag supp hyst","description":"Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed medical evacuation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58294","name":"Vag hyst w/enterocele compl","description":"Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76819","name":"Fetal biophys profil w/o nst","description":"Fetal biophysical profile; without non-stress testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67950","name":"Revision of eyelid","description":"Canthoplasty (reconstruction of canthus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0070","name":"Rr whl compl pne tire rep ea","description":"Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88369","name":"M/phmtrc alysishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62328","name":"Dx lmbr spi pnxr w/fluor/ct","description":"Spinal puncture, lumbar, diagnostic; with fluoroscopic or ct guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62355","name":"Remove spinal canal catheter","description":"Removal of previously implanted intrathecal or epidural catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97804","name":"Medical nutrition group","description":"Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31230","name":"Removal of upper jaw","description":"Maxillectomy; with orbital exenteration (en bloc)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1518.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61698","name":"Brain aneurysm repr complx","description":"Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4505.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87471","name":"Bartonella dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); bartonella henselae and bartonella quintana, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38747","name":"Remove abdominal lymph nodes","description":"Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and vena caval nodes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76604","name":"Us exam chest","description":"Ultrasound, chest (includes mediastinum), real time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0730","name":"Tens four lead","description":"Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27598","name":"Amputate lower leg at knee","description":"Disarticulation at knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42145","name":"Repair palate pharynx/uvula","description":"Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42955","name":"Surgical opening of throat","description":"Pharyngostomy (fistulization of pharynx, external for feeding)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78597","name":"Lung perfusion differential","description":"Quantitative differential pulmonary perfusion, including imaging when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4636","name":"Handgrip for cane etc","description":"Replacement, handgrip, cane, crutch, or walker, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26615","name":"Treat metacarpal fracture","description":"Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33263","name":"Rmvl & rplcmt dfb gen 2 lead","description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78478","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62302","name":"Myelography lumbar injection","description":"Myelography via lumbar injection, including radiological supervision and interpretation; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":206.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11954","name":"Subq njx fil matrl>10.0 cc","description":"Subcutaneous injection of filling material (eg, collagen); over 10.0 cc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84233","name":"Assay of estrogen","description":"Receptor assay; estrogen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42335","name":"Removal of salivary stone","description":"Sialolithotomy; submandibular (submaxillary), complicated, intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26842","name":"Thumb fusion with graft","description":"Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":660.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30462","name":"Revision of nose","description":"Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1226.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5643","name":"Hip flex inner socket ext fr","description":"Addition to lower extremity, hip disarticulation, flexible inner socket, external frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":772.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23472","name":"Reconstruct shoulder joint","description":"Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder))","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1227.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50220","name":"Remove kidney open","description":"Nephrectomy, including partial ureterectomy, any open approach including rib resection;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":863.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0861","name":"Halo repl liner/interface","description":"Addition to halo procedure, replacement liner/interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30120","name":"Revision of nose","description":"Excision or surgical planing of skin of nose for rhinophyma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42160","name":"Treatment mouth roof lesion","description":"Destruction of lesion, palate or uvula (thermal, cryo or chemical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0307","name":"Cbc without platelet","description":"Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79403","name":"Hematopoietic nuclear tx","description":"Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2520","name":"Th/wght bear quad-lat brim c","description":"Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37183","name":"Revision tips","description":"Revision of transvenous intrahepatic portosystemic shunt(s) (tips) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recannulization/dilatation, stent placement and all associated imaging guidance and documentation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15841","name":"Nerve palsy muscle graft","description":"Graft for facial nerve paralysis; free muscle graft (including obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1149.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29445","name":"Appl rigid tot cntc leg cast","description":"Application of rigid total contact leg cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85400","name":"Fibrinolytic plasmin","description":"Fibrinolytic factors and inhibitors; plasmin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4420","name":"Ost pch clsd for bar w lk fl","description":"Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25420","name":"Repair/graft radius & ulna","description":"Repair of nonunion or malunion, radius and ulna; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":987.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8621","name":"Repl zinc air battery","description":"Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47530","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1048.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51065","name":"Remove ureter calculus","description":"Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":468.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99223","name":"1st hosp ip/obs high 75","description":"Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 75 minutes must","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32960","name":"Therapeutic pneumothorax","description":"Pneumothorax, therapeutic, intrapleural injection of air","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2382","name":"Tube, pneum wheel drive tire","description":"Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0170","name":"Cervical collar molded to pt","description":"Cervical, collar, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24065","name":"Biopsy arm/elbow soft tissue","description":"Biopsy, soft tissue of upper arm or elbow area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95939","name":"C motor evoked upr&lwr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","name":"Office o/p est low 20 min","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 20 minutes must be met or e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2364","name":"U1nonsealed leadacid battery","description":"Power wheelchair accessory, u-1 non-sealed lead acid battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0672","name":"Pressure pneum appl full arm","description":"Segmental gradient pressure pneumatic appliance, full arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28294","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":614.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33617","name":"Repair single ventricle","description":"Repair of complex cardiac anomalies (eg, single ventricle) by modified fontan procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1881.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50130","name":"Pyelotomy w/removal calculus","description":"Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":835.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90887","name":"Interpj/explnaj rslt psyc xm","description":"Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26843","name":"Fusion of hand joint","description":"Arthrodesis, carpometacarpal joint, digit, other than thumb, each;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83633","name":"Test urine for lactose","description":"Lactose, urine, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31584","name":"Laryngoplasty fx rdctj fixj","description":"Laryngoplasty; with open reduction and fixation of (eg, plating) fracture, includes tracheostomy, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1053.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5811","name":"Endo knee-shin mnl lck ultra","description":"Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33141","name":"Heart tmr w/other procedure","description":"Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97129","name":"Ther ivntj 1st 15 min","description":"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57023","name":"I&d vaginal hematoma non-ob","description":"Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma, spontaneous bleeding)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49405","name":"Image cath fluid colxn visc","description":"Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0960","name":"W/c shoulder harness/straps","description":"Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35538","name":"Art byp grft aortobi-iliac","description":"Bypass graft, with vein; aortobi-iliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48551","name":"Prep donor pancreas","description":"Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and y-graft arterial anastomoses from iliac artery to superio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99480","name":"Sbsq ic inf pbw 2,501-5,000","description":"Subsequent intensive care, per day, for the evaluation and management of the recovering infant (present body weight of 2,501-5,000 grams)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39501","name":"Repair diaphragm laceration","description":"Repair, laceration of diaphragm, any approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":739.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92002","name":"Intrm oph exam new patient","description":"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1003","name":"Pwr seat recline","description":"Wheelchair accessory, power seating system, recline only, without shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73223","name":"Mri joint upr extr w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87380","name":"Hepatitis delta agent ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hepatitis, delta agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3911","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47136","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3397.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86611","name":"Bartonella antibody","description":"Antibody; bartonella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95955","name":"Eeg during surgery","description":"Electroencephalogram (eeg) during nonintracranial surgery (eg, carotid surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0453","name":"Cont intraop neuro monitor","description":"Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50980","name":"Ureter endoscopy & treatment","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26863","name":"Fuse/graft added joint","description":"Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft), each additional joint (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64802","name":"Sympathectomy cervical","description":"Sympathectomy, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":751.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40842","name":"Reconstruction of mouth","description":"Vestibuloplasty; posterior, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0304","name":"Hosp bed xtra hvy dty x wide","description":"Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52318","name":"Remove bladder stone","description":"Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":382.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83540","name":"Assay of iron","description":"Iron","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11450","name":"Exc skn hdrdnt ax smpl/ntrm","description":"Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":261.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5114","name":"Foam/fabric leg strap","description":"Leg strap; foam or fabric, replacement only, per set","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26260","name":"Resect prox finger tumor","description":"Radical resection of tumor, proximal or middle phalanx of finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":674.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73580","name":"Contrast x-ray of knee joint","description":"Radiologic examination, knee, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77047","name":"Mri breast c- bilateral","description":"Magnetic resonance imaging, breast, without contrast material; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92353","name":"Fit aphakia spectcl multifoc","description":"Fitting of spectacle prosthesis for aphakia; multifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27600","name":"Decompression of lower leg","description":"Decompression fasciotomy, leg; anterior and/or lateral compartments only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11621","name":"Exc s/n/h/f/g mal+mrg 0.6-1","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93315","name":"Echo transesophageal","description":"Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77772","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":715.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21423","name":"Optx palatal/max fx comp","description":"Open treatment of palatal or maxillary fracture (lefort i type); complicated (comminuted or involving cranial nerve foramina), multiple approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":627.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25400","name":"Repair radius or ulna","description":"Repair of nonunion or malunion, radius or ulna; without graft (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":673.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9987","name":"Bpci advanced in home visit","description":"Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/am","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75565","name":"Card mri veloc flow mapping","description":"Cardiac magnetic resonance imaging for velocity flow mapping (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33305","name":"Repair of heart wound","description":"Repair of cardiac wound; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27176","name":"Treat slipped epiphysis","description":"Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93505","name":"Endomyocardial biopsy","description":"Endomyocardial biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6452","name":"High compres band w>=3in<5inyd","description":"High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92512","name":"Nasal function studies","description":"Nasal function studies (eg, rhinomanometry)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62160","name":"Neuroendoscopy add-on","description":"Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S1040","name":"Cranial remolding orthosis","description":"Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2126","name":"Kafo fem fx cast thermoplas","description":"Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27650","name":"Repair achilles tendon","description":"Repair, primary, open or percutaneous, ruptured achilles tendon;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":542.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32940","name":"Revision of lung","description":"Pneumonolysis, extraperiosteal, including filling or packing procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87188","name":"Sc std macrobroth dil meth","description":"Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25109","name":"Excise tendon forearm/wrist","description":"Excision of tendon, forearm and/or wrist, flexor or extensor, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":448.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0517T","name":"Insj wcs lv both compnt pg","description":"Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; both components of pulse generator (battery and transmitter) only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32852","name":"Lung transplant with bypass","description":"Lung transplant, single; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2859.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48145","name":"Partial removal of pancreas","description":"Pancreatectomy, distal subtotal, with or without splenectomy; with pancreaticojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1371.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47000","name":"Needle biopsy of liver perq","description":"Biopsy of liver, needle; percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":237.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87483","name":"Cns dna amp probe type 12-25","description":"Infectious agent detection by nucleic acid (dna or rna); central nervous system pathogen (eg, neisseria meningitidis, streptococcus pneumoniae, listeria, haemophilus influenzae, e. coli, streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7013","name":"Disposable compressor filter","description":"Filter, disposable, used with aerosol compressor or ultrasonic generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36225","name":"Place cath subclavian art","description":"Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1260.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61575","name":"Skull base/brainstem surgery","description":"Transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2303.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50606","name":"Endoluminal bx urtr rnl plvs","description":"Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":502.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0274T","name":"Prq lamot/lam dcmpr crv/thrc","description":"Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, ct), single or multiple levels, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91040","name":"Esoph balloon distension tst","description":"Esophageal balloon distension study, diagnostic, with provocation when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6018","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3360","name":"Shoe sole wedge outside sole","description":"Sole wedge, outside sole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57305","name":"Repair rectum-vagina fistula","description":"Closure of rectovaginal fistula; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":627.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5634","name":"Symes type poster opening so","description":"Addition to lower extremity, symes type, posterior opening (canadian) socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15152","name":"Tis cltr skn agrft t/a/l ea","description":"Tissue cultured skin autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59140","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; cervical, with evacuation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84157","name":"Assay of protein other","description":"Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73221","name":"Mri joint upr extrem w/o dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4536","name":"Reusable pull-on any size","description":"Incontinence product, protective underwear/pull-on, reusable, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0440T","name":"Abltj perc uxtr/perph nrv","description":"Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11105","name":"Punch bx skin ea sep/addl","description":"Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30210","name":"Nasal sinus therapy","description":"Displacement therapy (proetz type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99177","name":"Ocular instrumnt screen bil","description":"Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with on-site analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27137","name":"Revise hip joint replacement","description":"Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1249.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1240","name":"Whchr litwt det arm leg rest","description":"Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4220","name":"Parenteral supply kit premix","description":"Parenteral nutrition supply kit; premix, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2061","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96423","name":"Chemo ia infuse each addl hr","description":"Chemotherapy administration, intra-arterial; infusion technique, each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3224","name":"Womans shoe oxford brace","description":"Orthopedic footwear, womans shoe, oxford, used as an integral part of a brace (orthosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35626","name":"Bpg aor-subcla/innom/carotid","description":"Bypass graft, with other than vein; aortosubclavian, aortoinnominate, or aortocarotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1387.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0314","name":"Counsel immune <21 16-30 m","description":"Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 16-30 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0447","name":"Behavior counsel obesity 15m","description":"Face-to-face behavioral counseling for obesity, 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61526","name":"Removal of brain lesion","description":"Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81271","name":"Htt gene detc abnor alleles","description":"Htt (huntingtin) (eg, huntington disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6444","name":"Conform band n/s w>=5in/yd","description":"Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21920","name":"Biopsy soft tissue of back","description":"Biopsy, soft tissue of back or flank; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42440","name":"Excise submaxillary gland","description":"Excision of submandibular (submaxillary) gland","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69930","name":"Implant cochlear device","description":"Cochlear device implantation, with or without mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4392","name":"Urinary pouch w st wear barr","description":"Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0442","name":"Annual alcohol screen 15 min","description":"Annual alcohol misuse screening, 5 to 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28088","name":"Excise foot tendon sheath","description":"Synovectomy, tendon sheath, foot; extensor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98926","name":"Osteopath manj 3-4 regions","description":"Osteopathic manipulative treatment (omt); 3-4 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41150","name":"Tongue mouth jaw surgery","description":"Glossectomy; composite procedure with resection floor of mouth and mandibular resection, without radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1705.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96365","name":"Ther/proph/diag iv inf init","description":"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44128","name":"Enterectomy cong add-on","description":"Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; each additional resection and anastomosis (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27685","name":"Revision of lower leg tendon","description":"Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":540.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27605","name":"Incision of achilles tendon","description":"Tenotomy, percutaneous, achilles tendon (separate procedure); local anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1093","name":"Wheelchair wide w/ foot rest","description":"Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6694","name":"Elbow socket ins use w/lock","description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58544","name":"Lsh w/t/o uterus above 250 g","description":"Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69720","name":"Release facial nerve","description":"Decompression facial nerve, intratemporal; lateral to geniculate ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42970","name":"Control nose/throat bleeding","description":"Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); simple, with posterior nasal packs, with or without anterior packs and/or cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43620","name":"Removal of stomach","description":"Gastrectomy, total; with esophagoenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1666.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90945","name":"Dialysis one evaluation","description":"Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85060","name":"Blood smear interpretation","description":"Blood smear, peripheral, interpretation by physician with written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21725","name":"Revision of neck muscle","description":"Division of sternocleidomastoid for torticollis, open operation; with cast application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6570","name":"Scap thorac prosth tiss shap","description":"Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2312.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6955","name":"Above elbow myoelectronic ct","description":"Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5925.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42894","name":"Revision of pharyngeal walls","description":"Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1836.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7034","name":"Nasal application device","description":"Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64901","name":"Nerve graft add-on","description":"Nerve graft, each additional nerve; single strand (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":509.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61642","name":"Dilat ic vspsm ea diff ter","description":"Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99082","name":"Unusual physician travel","description":"Unusual travel (eg, transportation and escort of patient)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5688","name":"Bk waist belt webbing","description":"Addition to lower extremity, below knee, waist belt, webbing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11463","name":"Exc skn hdrdnt ing complex","description":"Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":330.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77285","name":"Ther rad simulaj field intrm","description":"Therapeutic radiology simulation-aided field setting; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76516","name":"Echo exam of eye","description":"Ophthalmic biometry by ultrasound echography, a-scan;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68750","name":"Create tear duct drain","description":"Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":493.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86280","name":"Hemagglutination inhibition","description":"Hemagglutination inhibition test (hai)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24130","name":"Excision radial head","description":"Excision, radial head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":427.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85651","name":"Rbc sed rate nonautomated","description":"Sedimentation rate, erythrocyte; non-automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19281","name":"Perq device breast 1st imag","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89141","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1110","name":"Wheelchair semi-recl detach","description":"Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86226","name":"Dna antibody single strand","description":"Deoxyribonucleic acid (dna) antibody; single stranded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0156","name":"Walker seat attachment","description":"Seat attachment, walker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20703","name":"Rmvl imed rx delivery device","description":"Removal of drug-delivery device(s), intramedullary (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29873","name":"Arthrs knee surg w/lat rls","description":"Arthroscopy, knee, surgical; with lateral release","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":443.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50948","name":"Laparo new ureter/bladder","description":"Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2212","name":"Pneumatic prop tire tube","description":"Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32141","name":"Remove/treat lung lesions","description":"Thoracotomy; with resection-plication of bullae, includes any pleural procedure when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1219.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69501","name":"Mastoidectomy","description":"Transmastoid antrotomy (simple mastoidectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":579.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0017","name":"Detach adjust armrest base","description":"Detachable, adjustable height armrest, base, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72072","name":"X-ray exam thorac spine 3vws","description":"Radiologic examination, spine; thoracic, 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84140","name":"Assay of pregnenolone","description":"Pregnenolone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93644","name":"Ep eval subq impl dfb","description":"Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92014","name":"Compre oph exam est pt 1/>","description":"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8041","name":"Midfacial prosthesis","description":"Midfacial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","KM","95","93","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24357","name":"Repair elbow perc","description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfers elbow); percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00600","name":"Anes px crv spine&cord nos","description":"Anesthesia for procedures on cervical spine and cord; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77076","name":"Radex osseous survey infant","description":"Radiologic examination, osseous survey, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95125","name":"Immunotherapy 2/> injections","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 or more injections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33505","name":"Repair artery w/tunnel","description":"Repair of anomalous coronary artery from pulmonary artery origin; with construction of intrapulmonary artery tunnel (takeuchi procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1799.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66184","name":"Revision of aqueous shunt","description":"Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82491","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33502","name":"Coronary artery correction","description":"Repair of anomalous coronary artery from pulmonary artery origin; by ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1060","name":"Thoracic pad","description":"Addition to ctlso or scoliosis orthosis, thoracic pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80184","name":"Assay of phenobarbital","description":"Phenobarbital","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93293","name":"Pm phone r-strip device eval","description":"Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29844","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; synovectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":417.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82658","name":"Enzyme cell activity ra","description":"Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; radioactive substrate, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82552","name":"Assay of cpk in blood","description":"Creatine kinase (ck), (cpk); isoenzymes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46751","name":"Repair of anal sphincter","description":"Sphincteroplasty, anal, for incontinence or prolapse; child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":547.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23465","name":"Repair shoulder capsule","description":"Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6534","name":"Gc stocking thighlngth 30-40","description":"Gradient compression stocking, thigh length, 30-40 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51800","name":"Revision of bladder/urethra","description":"Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck (anterior y-plasty, vesical fundus resection), any procedure, with or without wedge resection of posterior vesical neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5616","name":"Ak univ multiplex sys frict","description":"Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":674.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57500","name":"Biopsy of cervix","description":"Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95954","name":"Eeg monitoring/giving drugs","description":"Pharmacological or physical activation requiring physician or other qualified health care professional attendance during eeg recording of activation phase (eg, thiopental activation test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":261.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67974","name":"Reconstruction of eyelid","description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":556.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84145","name":"Procalcitonin (pct)","description":"Procalcitonin (pct)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37722","name":"Lig div&strpg long saph vein","description":"Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0482","name":"Tlso rigid lined custom fab","description":"Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts g","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":892.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27035","name":"Denervation of hip joint","description":"Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":895.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64740","name":"Incision of tongue nerve","description":"Transection or avulsion of; lingual nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":375.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83913","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2206","name":"Man wc whl lock comp repl ea","description":"Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4639","name":"Infrared ht sys replcmnt pad","description":"Replacement pad for infrared heating pad system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3560","name":"O shoe add horseshoe toe tap","description":"Orthopedic shoe addition, toe tap, horseshoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27415","name":"Osteochondral knee allograft","description":"Osteochondral allograft, knee, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1162.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81185","name":"Cacna1a gene full gene seq","description":"Cacna1a (calcium voltage-gated channel subunit alpha1 a) (eg, spinocerebellar ataxia) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57250","name":"Repair rectum & vagina","description":"Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":387.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1930","name":"Afo plastic","description":"Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96371","name":"Sc ther infusion reset pump","description":"Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47361","name":"Repair liver wound","description":"Management of liver hemorrhage; exploration of hepatic wound, extensive debridement, coagulation and/or suture, with or without packing of liver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2527.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97166","name":"Ot eval mod complex 45 min","description":"Occupational therapy evaluation, moderate complexity, requiring these components: an occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current func","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50327","name":"Prep renal graft/venous","description":"Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33504","name":"Coronary artery graft","description":"Repair of anomalous coronary artery from pulmonary artery origin; by graft, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1269.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53020","name":"Incision of urethra","description":"Meatotomy, cutting of meatus (separate procedure); except infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76826","name":"Echo exam of fetal heart","description":"Echocardiography, fetal, cardiovascular system, real time with image documentation (2d), with or without m-mode recording; follow-up or repeat study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35511","name":"Art byp grft subclav-subclav","description":"Bypass graft, with vein; subclavian-subclavian","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95725","name":"Eeg phy/qhp>84 hr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of eeg recording, without video","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93454","name":"Coronary artery angio s&i","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":918.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92250","name":"Fundus photography w/i&r","description":"Fundus photography with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3020","name":"Foot longitud/metatarsal sup","description":"Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01150","name":"Anes rad px tumor of pelvis","description":"Anesthesia for radical procedures for tumor of pelvis, except hindquarter amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29838","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; debridement, extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":496.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27218","name":"Treat pelvic ring fracture","description":"Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes ipsilateral ilium, sacroiliac joint and/or sacrum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":916.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25115","name":"Remove wrist/forearm lesion","description":"Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, tbc, or other granulomas, rheumatoid arthritis); flexors","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35565","name":"Art byp grft iliofemoral","description":"Bypass graft, with vein; iliofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1152.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77431","name":"Radiation therapy management","description":"Radiation therapy management with complete course of therapy consisting of 1 or 2 fractions only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87903","name":"Phenotype dna hiv w/culture","description":"Infectious agent phenotype analysis by nucleic acid (dna or rna) with drug resistance tissue culture analysis, hiv 1; first through 10 drugs tested","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74260","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52317","name":"Remove bladder stone","description":"Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":706.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0826","name":"Pwc gp 2 vhd seat/back","description":"Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4250","name":"Urine reagent strips/tablets","description":"Urine test or reagent strips or tablets (100 tablets or strips)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23412","name":"Repair rotator cuff chronic","description":"Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97002","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24155","name":"Resection of elbow joint","description":"Resection of elbow joint (arthrectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":720.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97607","name":"Neg prs wnd thr ndme<=50sqcm","description":"Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surfac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87632","name":"Resp virus 6-11 targets","description":"Infectious agent detection by nucleic acid (dna or rna); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82043","name":"Ur albumin quantitative","description":"Albumin; urine (eg, microalbumin), quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61313","name":"Crnec/crnot sttl icere","description":"Craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1811.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84442","name":"Assay of thyroid activity","description":"Thyroxine binding globulin (tbg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01962","name":"Anes urgent hysterectomy","description":"Anesthesia for urgent hysterectomy following delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65420","name":"Removal of eye lesion","description":"Excision or transposition of pterygium; without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31612","name":"Perq trchl pnxr ttrach aspir","description":"Tracheal puncture, percutaneous with transtracheal aspiration and/or injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36160","name":"Establish access to aorta","description":"Introduction of needle or intracatheter, aortic, translumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61490","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1556.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78305","name":"Bone imaging multiple areas","description":"Bone and/or joint imaging; multiple areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55535","name":"Revise spermatic cord veins","description":"Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01963","name":"Anes cesarean hysterectomy","description":"Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36575","name":"Repair tunneled cv cath","description":"Repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump, central or peripheral insertion site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87528","name":"Hsv dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); herpes simplex virus, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0281","name":"Elec stim unattend for press","description":"Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27033","name":"Arthrt hip expl/rmv loose/fb","description":"Arthrotomy, hip, including exploration or removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50385","name":"Change stent via transureth","description":"Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42400","name":"Biopsy of salivary gland","description":"Biopsy of salivary gland; needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15852","name":"Dressing change not for burn","description":"Dressing change (for other than burns) under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52327","name":"Cystoscopy inject material","description":"Cystourethroscopy (including ureteral catheterization); with subureteric injection of implant material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92507","name":"Tx sp lang voice comm indiv","description":"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2602","name":"Gen w/c cushion wdth >=22 in","description":"General use wheelchair seat cushion, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43197","name":"Esophagoscopy flex dx brush","description":"Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69631","name":"Repair eardrum structures","description":"Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":713.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78305","name":"Bone imaging multiple areas","description":"Bone and/or joint imaging; multiple areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32900","name":"Removal of rib(s)","description":"Resection of ribs, extrapleural, all stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1134.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69632","name":"Rebuild eardrum structures","description":"Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42700","name":"I&d abscess peritonsillar","description":"Incision and drainage abscess; peritonsillar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93990","name":"Doppler flow testing","description":"Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4212","name":"Non coring needle or stylet","description":"Non-coring needle or stylet with or without catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43252","name":"Egd optical endomicroscopy","description":"Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86816","name":"Hla typing dr/dq","description":"Hla typing; dr/dq, single antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84155","name":"Assay of protein serum","description":"Protein, total, except by refractometry; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1751","name":"Cath, inf, per/cent/midline","description":"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78414","name":"Non-imaging heart function","description":"Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without pharmacologic intervention or exercise, single or multiple determinations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92585","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15832","name":"Exc excessive skin thigh","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":594.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6590","name":"Shdr fair lead cable direct","description":"Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1333.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5966","name":"Hip flexible cover system","description":"Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":651.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00522","name":"Anes clsd ch px ndl bx pleur","description":"Anesthesia for closed chest procedures; needle biopsy of pleura","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32035","name":"Thoracostomy w/rib resection","description":"Thoracostomy; with rib resection for empyema","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1310","name":"Whirlpool non-portable","description":"Whirlpool, non-portable (built-in type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32998","name":"Ablate pulm tumor perq rf","description":"Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26410","name":"Repair hand tendon","description":"Repair, extensor tendon, hand, primary or secondary; without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61020","name":"Remove brain cavity fluid","description":"Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47700","name":"Exploration of bile ducts","description":"Exploration for congenital atresia of bile ducts, without repair, with or without liver biopsy, with or without cholangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27638","name":"Remove/graft leg bone lesion","description":"Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01634","name":"Anes open/arthrs sho disrtcj","description":"Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; shoulder disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7018","name":"Water distilled w/nebulizer","description":"Water, distilled, used with large volume nebulizer, 1000 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4199","name":"Parenteral sol > 100gm prote","description":"Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62010","name":"Treatment of head injury","description":"Elevation of depressed skull fracture; with repair of dura and/or debridement of brain","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00215","name":"Anes icr px crnop/elvtn fx","description":"Anesthesia for intracranial procedures; cranioplasty or elevation of depressed skull fracture, extradural (simple or compound)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34711","name":"Dlyd plmt xtn prosth ea addl","description":"Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90863","name":"Pharmacologic mgmt w/psytx","description":"Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4387","name":"Non-pneum walk boot pre ots","description":"Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66852","name":"Removal of lens material","description":"Removal of lens material; pars plana approach, with or without vitrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2211","name":"Lens sphcy bifo 7.25-12/.25-","description":"Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51841","name":"Attach bladder/urethra","description":"Anterior vesicourethropexy, or urethropexy (eg, marshall-marchetti-krantz, burch); complicated (eg, secondary repair)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86738","name":"Mycoplasma antibody","description":"Antibody; mycoplasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44705","name":"Prepare fecal microbiota","description":"Preparation of fecal microbiota for instillation, including assessment of donor specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47382","name":"Percut ablate liver rf","description":"Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74210","name":"X-ray xm phrnx&/crv esoph c+","description":"Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01730","name":"Anes clsd px humerus&elbow","description":"Anesthesia for all closed procedures on humerus and elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64786","name":"Remove sciatic nerve lesion","description":"Excision of neuroma; sciatic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1006","name":"Pwr seat combo w/o shear","description":"Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0318","name":"Prolong home eval add 15m","description":"Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8687","name":"Implt nrostm pls gen dua rec","description":"Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3971","name":"Sewho cap design w/jnt(s) cf","description":"Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":833.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82340","name":"Assay of calcium in urine","description":"Calcium; urine quantitative, timed specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36222","name":"Place cath carotid/inom art","description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35207","name":"Rpr bld vsl dir hand finger","description":"Repair blood vessel, direct; hand, finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":631.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70492","name":"Ct sft tsue nck w/o & w/dye","description":"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49323","name":"Laparo drain lymphocele","description":"Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":529.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83893","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85410","name":"Fibrinolytic antiplasmin","description":"Fibrinolytic factors and inhibitors; alpha-2 antiplasmin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73550","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33877","name":"Thoracoabdominal graft","description":"Repair of thoracoabdominal aortic aneurysm with graft, with or without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87551","name":"Mycobacteria dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria species, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01380","name":"Anes all clsd px knee joint","description":"Anesthesia for all closed procedures on knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72072","name":"X-ray exam thorac spine 3vws","description":"Radiologic examination, spine; thoracic, 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86832","name":"Hla class i high defin qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), hla class i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8460","name":"Shrinker above knee","description":"Prosthetic shrinker, above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46255","name":"Remove int/ext hem 1 group","description":"Hemorrhoidectomy, internal and external, single column/group;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84305","name":"Assay of somatomedin","description":"Somatomedin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2250","name":"Foot plate molded stirrup at","description":"Addition to lower extremity, foot plate, molded to patient model, stirrup attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20969","name":"Bone/skin graft microvasc","description":"Free osteocutaneous flap with microvascular anastomosis; other than iliac crest, metatarsal, or great toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2241.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82553","name":"Creatine mb fraction","description":"Creatine kinase (ck), (cpk); mb fraction only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37193","name":"Rem endovas vena cava filter","description":"Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43286","name":"Esphg tot w/laps moblj","description":"Esophagectomy, total or near total, with laparoscopic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, laparoscopic transhiatal esophagectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33926","name":"Repr pul art unifocal w/cpb","description":"Repair of pulmonary artery arborization anomalies by unifocalization; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2106.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00604","name":"Anes px crv spn&cord sitting","description":"Anesthesia for procedures on cervical spine and cord; procedures with patient in the sitting position","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58291","name":"Vag hyst incl t/o complex","description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33416","name":"Revise ventricle muscle","description":"Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis (eg, asymmetric septal hypertrophy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1755.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88241","name":"Frozen cell preparation","description":"Thawing and expansion of frozen cells, each aliquot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15574","name":"Pedcle fh/ch/ch/m/n/ax/g/h/f","description":"Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95865","name":"Needle emg larynx","description":"Needle electromyography; larynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11762","name":"Reconstruction of nail bed","description":"Reconstruction of nail bed with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43265","name":"Ercp lithotripsy calculi","description":"Endoscopic retrograde cholangiopancreatography (ercp); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":332.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21720","name":"Revision of neck muscle","description":"Division of sternocleidomastoid for torticollis, open operation; without cast application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":464.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77076","name":"Radex osseous survey infant","description":"Radiologic examination, osseous survey, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0652","name":"Pneum compres w/cal pressure","description":"Pneumatic compressor, segmental home model with calibrated gradient pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88360","name":"Tumor immunohistochem/manual","description":"Morphometric analysis, tumor immunohistochemistry (eg, her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0056","name":"Seat ht <17 or >=21 ltwt wc","description":"Seat height less than 17 or equal to or greater than 21 for a high strength, lightweight, or ultralightweight wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47460","name":"Incise bile duct sphincter","description":"Transduodenal sphincterotomy or sphincteroplasty, with or without transduodenal extraction of calculus (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1064.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33987","name":"Artery expos/graft artery","description":"Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ecmo/ecls (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62160","name":"Neuroendoscopy add-on","description":"Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56440","name":"Mrsplzatn brthlns glnd cst","description":"Marsupialization of bartholins gland cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27197","name":"Clsd tx pelvic ring fx","description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; without","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28050","name":"Biopsy of foot joint lining","description":"Arthrotomy with biopsy; intertarsal or tarsometatarsal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91110","name":"Gi trc img intral esoph-ile","description":"Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78457","name":"Venous thrombosis imaging","description":"Venous thrombosis imaging, venogram; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36595","name":"Mech remov tunneled cv cath","description":"Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0404","name":"Ekg tracing for initial prev","description":"Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64885","name":"Nerve graft head/neck <4 cm","description":"Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":910.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82365","name":"Calculus spectroscopy","description":"Calculus; infrared spectroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0436","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44133","name":"Enterectomy live donor","description":"Donor enterectomy (including cold preservation), open; partial, from living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29893","name":"Endoscopic plantr fasciotomy","description":"Endoscopic plantar fasciotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87250","name":"Virus inoculate eggs/animal","description":"Virus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43334","name":"Transthor diaphrag hern rpr","description":"Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1036.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26776","name":"Pin finger dislocation","description":"Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87486","name":"Chlmyd pneum dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia pneumoniae, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27725","name":"Repair of lower leg","description":"Repair of nonunion or malunion, tibia; by synostosis, with fibula, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27745","name":"Reinforce tibia","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17286","name":"Dstr mal ls f/e/e/n/l/m>4.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77411","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92270","name":"Electro-oculography w/i&r","description":"Electro-oculography with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24560","name":"Cltx hum epcndylr fx wo mnpj","description":"Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":272.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2350","name":"Prosthetic type socket molde","description":"Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for ptb afo orthoses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99152","name":"Mod sed same phys/qhp 5/>yrs","description":"Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9870","name":"Cmmi asyntelehealth >20min","description":"Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P2038","name":"Blood mucoprotein","description":"Mucoprotein, blood (seromucoid) (medical necessity procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43502","name":"Surgical repair of stomach","description":"Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg, mallory-weiss)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1280.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0627","name":"Seat lift mech, electric any","description":"Seat lift mechanism, electric, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35691","name":"Art trnsposj vertbrl carotid","description":"Transposition and/or reimplantation; vertebral to carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":833.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50785","name":"Reimplant ureter in bladder","description":"Ureteroneocystostomy; with vesico-psoas hitch or bladder flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7002","name":"Tubing used w suction pump","description":"Tubing, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74400","name":"Urography iv +-kub tomog","description":"Urography (pyelography), intravenous, with or without kub, with or without tomography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93978","name":"Vascular study","description":"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69205","name":"Clear outer ear canal","description":"Removal foreign body from external auditory canal; with general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77328","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73085","name":"Contrast x-ray of elbow","description":"Radiologic examination, elbow, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37214","name":"Cessj therapy cath removal","description":"Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30580","name":"Repair upper jaw fistula","description":"Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":459.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4233","name":"Alkalin batt for glucose mon","description":"Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","KL","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53250","name":"Removal of urethra gland","description":"Excision of bulbourethral gland (cowpers gland)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50075","name":"Nl rmvl lg staghorn calculus","description":"Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1178.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80198","name":"Assay of theophylline","description":"Theophylline","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41010","name":"Incision of tongue fold","description":"Incision of lingual frenum (frenotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":162.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40527","name":"Reconstruct lip with flap","description":"Excision of lip; full thickness, reconstruction with cross lip flap (abbe-estlander)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25931","name":"Amputation follow-up surgery","description":"Transmetacarpal amputation; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":643.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45541","name":"Correct rectal prolapse","description":"Proctopexy (eg, for prolapse); perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88371","name":"Protein western blot tissue","description":"Protein analysis of tissue by western blot, with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47531","name":"Injection for cholangiogram","description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":296.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6975","name":"Interscap-thor myoelectronic","description":"Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7928.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68130","name":"Exc les conjunctiva adj scl","description":"Excision of lesion, conjunctiva; with adjacent sclera","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93298","name":"Rem interrog dev eval scrms","description":"Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74190","name":"Peritoneogram rs&i","description":"Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76100","name":"X-ray exam of body section","description":"Radiologic examination, single plane body section (eg, tomography), other than with urography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57307","name":"Fistula repair & colostomy","description":"Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":660.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87527","name":"Hepatitis g dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis g, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00400","name":"Anes integumentary sys nos","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57150","name":"Treat vagina infection","description":"Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96131","name":"Psycl tst eval phys/qhp ea","description":"Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23605","name":"Cltx prx hmrl fx mnpj+-tract","description":"Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73701","name":"Ct lower extremity w/dye","description":"Computed tomography, lower extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43881","name":"Impl/rplcmt gstr nstim eltrd","description":"Implantation or replacement of gastric neurostimulator electrodes, antrum, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35533","name":"Art byp grft axill/fem/fem","description":"Bypass graft, with vein; axillary-femoral-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1331.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85705","name":"Thromboplastin inhibition","description":"Thromboplastin inhibition, tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43460","name":"Pressure treatment esophagus","description":"Esophagogastric tamponade, with balloon (sengstaken type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8189","name":"Trach supply noc","description":"Tracheostomy supply, not otherwise classified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82785","name":"Assay of ige","description":"Gammaglobulin (immunoglobulin); ige","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97124","name":"Massage therapy","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86378","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0112","name":"Cranial cervical orthosis","description":"Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4370","name":"Pneum full leg splnt pre ots","description":"Pneumatic full leg splint, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80174","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37218","name":"Stent placemt ante carotid","description":"Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67560","name":"Revise eye socket implant","description":"Orbital implant (implant outside muscle cone); removal or revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78018","name":"Thyroid met imaging body","description":"Thyroid carcinoma metastases imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95869","name":"Ndl emg thrc paraspinal musc","description":"Needle electromyography; thoracic paraspinal muscles (excluding t1 or t12)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97032","name":"Appl modality 1+estim ea 15","description":"Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90967","name":"Esrd svc pr day pt <2","description":"End-stage renal disease (esrd) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70015","name":"Contrast x-ray of brain","description":"Cisternography, positive contrast, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87116","name":"Mycobacteria culture","description":"Culture, tubercle or other acid-fast bacilli (eg, tb, afb, mycobacteria) any source, with isolation and presumptive identification of isolates","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0642","name":"Lo sag ri an/pos pnl pre ots","description":"Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefab","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5695","name":"Ak sleeve susp neoprene/equa","description":"Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52343","name":"Cysto w/renal stricture tx","description":"Cystourethroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92019","name":"Lmtd oph exam general anes","description":"Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63051","name":"C-laminoplasty w/graft/plate","description":"Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [eg, wire, suture, mini-plates], when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2362","name":"Gr24 nonsealed leadacid","description":"Power wheelchair accessory, group 24 non-sealed lead acid battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2430","name":"Knee jnt ratchet lock ea jnt","description":"Addition to knee joint, ratchet lock for active and progressive knee extension, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49250","name":"Excision of umbilicus","description":"Umbilectomy, omphalectomy, excision of umbilicus (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67311","name":"Revise eye muscle","description":"Strabismus surgery, recession or resection procedure; 1 horizontal muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31293","name":"Nsl/sins ndsc med&inf dcmprn","description":"Nasal/sinus endoscopy, surgical, with orbital decompression; medial and inferior wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21243","name":"Reconstruction of jaw joint","description":"Arthroplasty, temporomandibular joint, with prosthetic joint replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63710","name":"Graft repair of spine defect","description":"Dural graft, spinal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":955.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43832","name":"Gstrst open w/constj tube","description":"Gastrostomy, open; with construction of gastric tube (eg, janeway procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70370","name":"Throat x-ray & fluoroscopy","description":"Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35612","name":"Bpg subclavian-subclavian","description":"Bypass graft, with other than vein; subclavian-subclavian","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":919.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33215","name":"Reposition pacing-defib lead","description":"Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31571","name":"Laryngoscop w/vc inj + scope","description":"Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0420","name":"Ed svc ckd ind per session","description":"Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0840","name":"Tract frame attach headboard","description":"Traction frame, attached to headboard, cervical traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86003","name":"Allg spec ige crude xtrc ea","description":"Allergen specific ige; quantitative or semiquantitative, crude allergen extract, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38305","name":"Drainage lymph node lesion","description":"Drainage of lymph node abscess or lymphadenitis; extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11302","name":"Shave skin lesion 1.1-2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69421","name":"Incision of eardrum","description":"Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4371","name":"Skin barrier powder per oz","description":"Ostomy skin barrier, powder, per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77372","name":"Srs linear based","description":"Radiation treatment delivery, stereotactic radiosurgery (srs), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":848.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5688","name":"Bk waist belt webbing","description":"Addition to lower extremity, below knee, waist belt, webbing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2205","name":"Lens sphcy bifocal 4.00d/4.2","description":"Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44820","name":"Excision of mesentery lesion","description":"Excision of lesion of mesentery (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72148","name":"Mri lumbar spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57022","name":"I&d vaginal hematoma ob/pp","description":"Incision and drainage of vaginal hematoma; obstetrical/postpartum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92548","name":"Cdp-sot 6 cond w/i&r","description":"Computerized dynamic posturography sensory organization test (cdp-sot), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93297","name":"Rem interrog dev eval icpms","description":"Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other quali","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78730","name":"Urinary bladder retention","description":"Urinary bladder residual study (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64840","name":"Repair of leg nerve","description":"Suture of posterior tibial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":814.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64702","name":"Revise finger/toe nerve","description":"Neuroplasty; digital, 1 or both, same digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0106T","name":"Touch quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using touch pressure stimuli to assess large diameter sensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01852","name":"Anes px vn f/arm phlbrrhaphy","description":"Anesthesia for procedures on veins of forearm, wrist, and hand; phleborrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1830","name":"Adjust toe ext & flex device","description":"Dynamic adjustable toe extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97016","name":"Vasopneumatic device therapy","description":"Application of a modality to 1 or more areas; vasopneumatic devices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58180","name":"Partial hysterectomy","description":"Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":615.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1226","name":"Manual fully reclining back","description":"Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82101","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44376","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86808","name":"Cytotoxic antibody screening","description":"Serum screening for cytotoxic percent reactive antibody (pra); quick method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90857","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24105","name":"Excision olecranon bursa","description":"Excision, olecranon bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1700","name":"Leg perthes orth toronto typ","description":"Legg perthes orthosis, (toronto type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41005","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21155","name":"Rcnstj mdfc lefort iii w/i","description":"Reconstruction midface, lefort iii (extracranial), any type, requiring bone grafts (includes obtaining autografts); with lefort i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40840","name":"Reconstruction of mouth","description":"Vestibuloplasty; anterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":649.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6615","name":"Disconnect locking wrist uni","description":"Upper extremity addition, disconnect locking wrist unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96161","name":"Caregiver health risk assmt","description":"Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4268","name":"Female condom","description":"Contraceptive supply, condom, female, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7013","name":"Disposable compressor filter","description":"Filter, disposable, used with aerosol compressor or ultrasonic generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88741","name":"Transcutaneous methb","description":"Hemoglobin, quantitative, transcutaneous, per day; methemoglobin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27256","name":"Treat hip dislocation","description":"Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66982","name":"Xcapsl ctrc rmvl cplx wo ecp","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":674.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78600","name":"Brain image < 4 views","description":"Brain imaging, less than 4 static views;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99396","name":"Prev visit est age 40-64","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28313","name":"Repair deformity of toe","description":"Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":427.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33986","name":"Ecmo/ecls rmvl ctr cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":457.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69910","name":"Remove inner ear & mastoid","description":"Labyrinthectomy; with mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84702","name":"Chorionic gonadotropin test","description":"Gonadotropin, chorionic (hcg); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83069","name":"Hemoglobin urine","description":"Hemoglobin; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0885","name":"Pwc gp4 std mult pow opt cap","description":"Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58900","name":"Biopsy of ovary(s)","description":"Biopsy of ovary, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0856","name":"Pwc gp3 std sing pow opt s/b","description":"Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26011","name":"Drainage of finger abscess","description":"Drainage of finger abscess; complicated (eg, felon)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12044","name":"Intmd rpr n-hf/genit7.6-12.5","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50930","name":"Closure ureter/bowel fistula","description":"Closure of ureterovisceral fistula (including visceral repair)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":892.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4627","name":"Spacer bag/reservoir","description":"Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61583","name":"Craniofacial approach skull","description":"Craniofacial approach to anterior cranial fossa; intradural, including unilateral or bifrontal craniotomy, elevation or resection of frontal lobe, osteotomy of base of anterior cranial fossa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2595.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97164","name":"Pt re-eval est plan care","description":"Re-evaluation of physical therapy established plan of care, requiring these components: an examination including a review of history and use of standardized tests and measures is required; and revised plan of care using a standardized patient assessment instrument and/or measurable assessment of fun","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0409","name":"Corf related serv 15 mins ea","description":"Social work and psychological services, directly relating to and/or furthering the patients rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43314","name":"Tracheo-esophagoplasty cong","description":"Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; with repair of congenital tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80420","name":"Dexamethasone panel","description":"Dexamethasone suppression panel, 48 hour this panel must include the following: free cortisol, urine (82530 x 2) cortisol (82533 x 2) volume measurement for timed collection (81050 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78120","name":"Red cell mass single","description":"Red cell volume determination (separate procedure); single sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78261","name":"Gastric mucosa imaging","description":"Gastric mucosa imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43763","name":"Rplc gtube revj gstrst trc","description":"Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2004","name":"Post-d/c h vst new pt 60 m","description":"Comprehensive (60 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient faci","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93294","name":"Rem interrog evl pm/ldls pm","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27200","name":"Treat tail bone fracture","description":"Closed treatment of coccygeal fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4408","name":"Ext wear ost skn barr >4sqin","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0012A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87905","name":"Ia nzmtc actv oth/thn virus","description":"Infectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0150","name":"Cerv semi-rig adj molded chn","description":"Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92014","name":"Compre oph exam est pt 1/>","description":"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61583","name":"Craniofacial approach skull","description":"Craniofacial approach to anterior cranial fossa; intradural, including unilateral or bifrontal craniotomy, elevation or resection of frontal lobe, osteotomy of base of anterior cranial fossa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46611","name":"Anoscopy","description":"Anoscopy; with removal of single tumor, polyp, or other lesion by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68135","name":"Destruction les conjunctiva","description":"Destruction of lesion, conjunctiva","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78290","name":"Intestine imaging","description":"Intestine imaging (eg, ectopic gastric mucosa, meckels localization, volvulus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67922","name":"Repair eyelid defect","description":"Repair of entropion; thermocauterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99386","name":"Prev visit new age 40-64","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94729","name":"Diffusing capacity","description":"Diffusing capacity (eg, carbon monoxide, membrane) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92018","name":"Compl oph exam general anes","description":"Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5241","name":"Dispensing fee, monaural","description":"Dispensing fee, monaural hearing aid, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0010","name":"Stnd wt frame power whlchr","description":"Standard - weight frame motorized/power wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L7261","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1777.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69602","name":"Rev mstdc rslt mod rad mstdc","description":"Revision mastoidectomy; resulting in modified radical mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72130","name":"Ct chest spine w/o & w/dye","description":"Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2628","name":"Fabrication & fitting","description":"Fabrication and fitting of ocular conformer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58110","name":"Bx done w/colposcopy add-on","description":"Endometrial sampling (biopsy) performed in conjunction with colposcopy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0040","name":"Adjustable angle footplate","description":"Adjustable angle footplate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27066","name":"Remove hip bone les deep","description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; deep (subfascial), includes autograft, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":683.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60540","name":"Explore adrenal gland","description":"Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":911.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95801","name":"Slp stdy unatnd w/anal","description":"Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41015","name":"Drainage of mouth lesion","description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":309.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0378T","name":"Visual field assmnt rev/rprt","description":"Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5685","name":"Below knee sus/seal sleeve","description":"Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4562","name":"Pessary reusable nonrubber","description":"Pessary, reusable, non rubber, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9561","name":"Tc99m oxidronate","description":"Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76820","name":"Umbilical artery echo","description":"Doppler velocimetry, fetal; umbilical artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42890","name":"Limited pharyngectomy","description":"Limited pharyngectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00865","name":"Anes xtrprt lwr abd prst8ect","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; radical prostatectomy (suprapubic, retropubic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33542","name":"Removal of heart lesion","description":"Myocardial resection (eg, ventricular aneurysmectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2009","name":"Post-d/c h vst ext pt 60 m","description":"Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatien","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32701","name":"Thorax stereo rad targetw/tx","description":"Thoracic target(s) delineation for stereotactic body radiation therapy (srs/sbrt), (photon or particle beam), entire course of treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31240","name":"Nsl/sns ndsc cnch bull rescj","description":"Nasal/sinus endoscopy, surgical; with concha bullosa resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87483","name":"Cns dna amp probe type 12-25","description":"Infectious agent detection by nucleic acid (dna or rna); central nervous system pathogen (eg, neisseria meningitidis, streptococcus pneumoniae, listeria, haemophilus influenzae, e. coli, streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80410","name":"Calcitonin stimul panel","description":"Calcitonin stimulation panel (eg, calcium, pentagastrin) this panel must include the following: calcitonin (82308 x 3)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88237","name":"Tissue culture bone marrow","description":"Tissue culture for neoplastic disorders; bone marrow, blood cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3420","name":"Full sole/heel wedge btween","description":"Full sole and heel wedge, between sole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43123","name":"Partial removal of esophagus","description":"Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3775.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4663","name":"Dialysis blood pressure cuff","description":"Blood pressure cuff only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75774","name":"Artery x-ray each vessel","description":"Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4386","name":"Non-pneum walk boot pre cst","description":"Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00872","name":"Anes lithotrp esw water bath","description":"Anesthesia for lithotripsy, extracorporeal shock wave; with water bath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0521T","name":"Interrog dev eval wcs ip","description":"Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording, and disconnection per patient encounter, wireless cardiac stimulator for left ventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29581","name":"Appl multlayer cmprn sys leg","description":"Application of multi-layer compression system; leg (below knee), including ankle and foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64795","name":"Biopsy of nerve","description":"Biopsy of nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":168.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92014","name":"Compre oph exam est pt 1/>","description":"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4234","name":"J-cell batt for glucose mon","description":"Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","KL","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1844","name":"Ko w/adj jt rot cntrl molded","description":"Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":761.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91037","name":"Esoph imped function test","description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99406","name":"Behav chng smoking 3-10 min","description":"Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94002","name":"Vent mgmt inpat init day","description":"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01770","name":"Anes px art upr arm&elbw nos","description":"Anesthesia for procedures on arteries of upper arm and elbow; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5505","name":"Init ak ischal plstr direct","description":"Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59070","name":"Transabdom amnioinfus w/us","description":"Transabdominal amnioinfusion, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73592","name":"X-ray exam of leg infant","description":"Radiologic examination; lower extremity, infant, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94690","name":"O2 uptk rest indirect","description":"Oxygen uptake, expired gas analysis; rest, indirect (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97032","name":"Appl modality 1+estim ea 15","description":"Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00450","name":"Anes px clav&scapula nos","description":"Anesthesia for procedures on clavicle and scapula; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43205","name":"Esophagus endoscopy/ligation","description":"Esophagoscopy, flexible, transoral; with band ligation of esophageal varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15937","name":"Exc sac pr ulc prep mus ostc","description":"Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":677.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85025","name":"Complete cbc w/auto diff wbc","description":"Blood count; complete (cbc), automated (hgb, hct, rbc, wbc and platelet count) and automated differential wbc count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54411","name":"Remov/replc penis pros comp","description":"Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":833.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65760","name":"Keratomileusis","description":"Keratomileusis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69725","name":"Release facial nerve","description":"Decompression facial nerve, intratemporal; including medial to geniculate ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1517.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89050","name":"Body fluid cell count","description":"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24545","name":"Optx hum fx wo ntrcndylr xtn","description":"Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; without intercondylar extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44227","name":"Lap close enterostomy","description":"Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26755","name":"Treat finger fracture each","description":"Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2395","name":"Offset knee joint heavy duty","description":"Addition to lower extremity, offset knee joint, heavy duty, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27441","name":"Revision of knee joint","description":"Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0239","name":"Oth resp proc, group","description":"Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15420","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":330.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30468","name":"Rpr nsl vlv collapse w/implt","description":"Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2149.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28645","name":"Repair toe dislocation","description":"Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28485","name":"Optx metatarsal fx each","description":"Open treatment of metatarsal fracture, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21356","name":"Opn tx dprsd zygomatic arch","description":"Open treatment of depressed zygomatic arch fracture (eg, gillies approach)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00215","name":"Anes icr px crnop/elvtn fx","description":"Anesthesia for intracranial procedures; cranioplasty or elevation of depressed skull fracture, extradural (simple or compound)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71040","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54110","name":"Treatment of penis lesion","description":"Excision of penile plaque (peyronie disease);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96440","name":"Chmotx admn plrl cav thrcnts","description":"Chemotherapy administration into pleural cavity, requiring and including thoracentesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54417","name":"Remv/replc penis pros compl","description":"Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67950","name":"Revision of eyelid","description":"Canthoplasty (reconstruction of canthus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":352.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87905","name":"Ia nzmtc actv oth/thn virus","description":"Infectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93568","name":"Njx car cth nslc p-art angrp","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82045","name":"Albumin ischemia modified","description":"Albumin; ischemia modified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36514","name":"Apheresis plasma","description":"Therapeutic apheresis; for plasma pheresis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4629","name":"Tracheostomy care kit","description":"Tracheostomy care kit for established tracheostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1876","name":"Stent, non-coa/non-cov w/del","description":"Stent, non-coated/non-covered, with delivery system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36425","name":"Venipuncture cutdown 1 yr/>","description":"Venipuncture, cutdown; age 1 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33621","name":"Transthor cath for stent","description":"Transthoracic insertion of catheter for stent placement with catheter removal and closure (eg, hybrid approach stage 1)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87230","name":"Toxin/antitoxin asy tiss cul","description":"Toxin or antitoxin assay, tissue culture (eg, clostridium difficile toxin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33955","name":"Ecmo/ecls insj ctr cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61140","name":"Burr hole/treph bx brain/les","description":"Burr hole(s) or trephine; with biopsy of brain or intracranial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1151.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4372","name":"Skin barrier solid 4x4 equiv","description":"Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31653","name":"Bronch ebus samplng 3/> node","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32540","name":"Removal of lung lesion","description":"Extrapleural enucleation of empyema (empyemectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1385.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26115","name":"Exc hand les sc < 1.5 cm","description":"Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; less than 1.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27732","name":"Repair of fibula epiphysis","description":"Arrest, epiphyseal (epiphysiodesis), open; distal fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":378.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0141","name":"Scr c/v cyto,autosys and md","description":"Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84378","name":"Sugars single quant","description":"Sugars (mono-, di-, and oligosaccharides); single quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62267","name":"Interdiscal perq aspir dx","description":"Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2415","name":"Knee joint cam lock each joi","description":"Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87901","name":"Nfct agt gntyp alys hiv1 rev","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); hiv-1, reverse transcriptase and protease regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83919","name":"Organic acids qual each","description":"Organic acids; qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35883","name":"Revj fem anast nonautog grf","description":"Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, polyester, eptfe, bovine pericardium)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0107T","name":"Vibrate quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using vibration stimuli to assess large diameter fiber sensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93925","name":"Lower extremity study","description":"Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93227","name":"Xtrnl ecg rec<48 hr r&i","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64580","name":"Opn impltj nea neuromuscular","description":"Open implantation of neurostimulator electrode array; neuromuscular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7038","name":"Pos airway pressure filter","description":"Filter, disposable, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53854","name":"Trurl dstrj prst8 tiss rf wv","description":"Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1452.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43843","name":"Gstr rstcv oth/thn v-band","description":"Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1075.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28230","name":"Incision of foot tendon(s)","description":"Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4770","name":"Blood collection tube/vacuum","description":"Blood collection tube, vacuum, for dialysis, per 50","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78801","name":"Rp loclzj tum 2+area 1+d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21261","name":"Revise eye sockets","description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11303","name":"Shave skin lesion >2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21555","name":"Exc neck les sc < 3 cm","description":"Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0481","name":"Microprcsr cu elec vad, rep","description":"Microprocessor control unit for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7077.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99377","name":"Hospice care supervision","description":"Supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2120","name":"Pulse gen sys tx endolymp fl","description":"Pulse generator system for tympanic treatment of inner ear endolymphatic fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87632","name":"Resp virus 6-11 targets","description":"Infectious agent detection by nucleic acid (dna or rna); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22864","name":"Rmvl tot arthrp 1ntrspc crv","description":"Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62350","name":"Implant spinal canal cath","description":"Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":333.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53860","name":"Transurethral rf treatment","description":"Transurethral radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0321","name":"Audio-only hhs","description":"Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":223.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7007","name":"Lg vol nebulizer disposable","description":"Large volume nebulizer, disposable, unfilled, used with aerosol compressor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30160","name":"Rhinectomy total","description":"Rhinectomy; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32160","name":"Open chest heart massage","description":"Thoracotomy; with cardiac massage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2607","name":"Skin pro/pos wc cus wd <22in","description":"Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93986","name":"Dup-scan hemo compl uni std","description":"Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97140","name":"Manual therapy 1/> regions","description":"Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88187","name":"Flowcytometry/read 2-8","description":"Flow cytometry, interpretation; 2 to 8 markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61314","name":"Crnec/crnot ittl xdrl/sdrl","description":"Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25530","name":"Cltx ulnar shft fx w/o mnpj","description":"Closed treatment of ulnar shaft fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77431","name":"Radiation therapy management","description":"Radiation therapy management with complete course of therapy consisting of 1 or 2 fractions only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45381","name":"Colonoscopy submucous njx","description":"Colonoscopy, flexible; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72127","name":"Ct neck spine w/o & w/dye","description":"Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4161","name":"Ef ped hydrolyzed/amino acid","description":"Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4722","name":"Dialys sol fld vol > 1999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0479","name":"Power module combo vad, rep","description":"Power module for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5876.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78708","name":"K flow/funct image w/drug","description":"Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28002","name":"Treatment of foot infection","description":"Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0255","name":"Hospital bed var ht w/ mattr","description":"Hospital bed, variable height, hi-lo, with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42310","name":"Drainage of salivary gland","description":"Drainage of abscess; submaxillary or sublingual, intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23552","name":"Optx acrclv dslc aq/chrn grf","description":"Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":548.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69433","name":"Create eardrum opening","description":"Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7505","name":"Hmes or trach valve housing","description":"Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63170","name":"Incise spinal cord tract(s)","description":"Laminectomy with myelotomy (eg, bischof or drez type), cervical, thoracic, or thoracolumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2850","name":"Femoral lgth sock fx or equa","description":"Addition to lower extremity orthosis, femoral length sock, fracture or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1100","name":"Whchr s-recl fxd arm leg res","description":"Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74018","name":"Radex abdomen 1 view","description":"Radiologic examination, abdomen; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49521","name":"Rerepair ing hernia blocked","description":"Repair recurrent inguinal hernia, any age; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":598.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50370","name":"Rmvl transplanted rnl algrft","description":"Removal of transplanted renal allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43635","name":"Removal of stomach partial","description":"Vagotomy when performed with partial distal gastrectomy (list separately in addition to code[s] for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10007","name":"Fna bx w/fluor gdn 1st les","description":"Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4629","name":"Tracheostomy care kit","description":"Tracheostomy care kit for established tracheostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34709","name":"Plmt xtn prosth evasc rpr","description":"Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer, including pre-procedure sizing and device selection, all nonselec","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":284.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0765","name":"Nerve stimulator for tx n&v","description":"Fda approved nerve stimulator, for treatment of nausea and vomiting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17340","name":"Cryotherapy for acne","description":"Cryotherapy (co2 slush, liquid n2) for acne","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15261","name":"Fth/gft fr n/e/e/l each addl","description":"Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24575","name":"Optx humeral epcndylr fx","description":"Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":615.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1088","name":"Wheelchair lightweight det a","description":"High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15787","name":"Abrasion lesions add-on","description":"Abrasion; each additional 4 lesions or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24310","name":"Tnot opn elbw to sho ea tdn","description":"Tenotomy, open, elbow to shoulder, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43755","name":"Dx gastr intub w/asp specs","description":"Gastric intubation and aspiration, diagnostic; collection of multiple fractional specimens with gastric stimulation, single or double lumen tube (gastric secretory study) (eg, histamine, insulin, pentagastrin, calcium, secretin), includes drug administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43420","name":"Repair esophagus opening","description":"Closure of esophagostomy or fistula; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92979","name":"Endoluminl ivus oct c ea","description":"Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (list separately in addition to co","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43135","name":"Removal of esophagus pouch","description":"Diverticulectomy of hypopharynx or esophagus, with or without myotomy; thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40530","name":"Partial removal of lip","description":"Resection of lip, more than one-fourth, without reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":424.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90821","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45915","name":"Remove rectal obstruction","description":"Removal of fecal impaction or foreign body (separate procedure) under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":271.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26489","name":"Transplant/graft palm tendon","description":"Transfer or transplant of tendon, palmar; with free tendon graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01932","name":"Anes th ivnt rad ntrthrc/jug","description":"Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intrathoracic or jugular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51702","name":"Insert temp bladder cath","description":"Insertion of temporary indwelling bladder catheter; simple (eg, foley)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35021","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, innominate, subclavian artery, by thoracic incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21365","name":"Opn tx complx malar fx","description":"Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":900.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26483","name":"Transplant/graft hand tendon","description":"Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free tendon graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":705.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26341","name":"Manipulat palm cord post inj","description":"Manipulation, palmar fascial cord (ie, dupuytrens cord), post enzyme injection (eg, collagenase), single cord","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28140","name":"Removal of metatarsal","description":"Metatarsectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":480.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0570T","name":"Ttvr perq ea addl prosth","description":"Transcatheter tricuspid valve repair, percutaneous approach; each additional prosthesis during same session (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93619","name":"Comprehensive ep evaluation","description":"Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, his bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":754.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9982","name":"Remote e/m new pt 60mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72110","name":"X-ray exam l-2 spine 4/>vws","description":"Radiologic examination, spine, lumbosacral; minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52344","name":"Cysto/uretero stricture tx","description":"Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85045","name":"Automated reticulocyte count","description":"Blood count; reticulocyte, automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6970","name":"Interscapular-thor switch ct","description":"Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7236.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77469","name":"Io radiation tx management","description":"Intraoperative radiation treatment management","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54220","name":"Irrg crpra cavrnosa priapism","description":"Irrigation of corpora cavernosa for priapism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63081","name":"Remove vert body dcmprn crvl","description":"Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1568.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83970","name":"Assay of parathormone","description":"Parathormone (parathyroid hormone)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77373","name":"Strtctc bdy rad ther tx dlvr","description":"Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93745","name":"Set-up cardiovert-defibrill","description":"Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ecg, transmission of data to data repository, patient instruction in wearing system and patient re","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49580","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50557","name":"Kidney endoscopy & treatment","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64479","name":"Njx aa&/strd tfrm epi c/t 1","description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or ct), cervical or thoracic, single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90937","name":"Hemodialysis repeated eval","description":"Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48100","name":"Biopsy of pancreas open","description":"Biopsy of pancreas, open (eg, fine needle aspiration, needle core biopsy, wedge biopsy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":734.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90955","name":"Esrd srv 2-3 vsts p mo 2-11","description":"End-stage renal disease (esrd) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per mo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74410","name":"Urography nfs drip&/bolus","description":"Urography, infusion, drip technique and/or bolus technique;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23802","name":"Arthrd glenohumeral jt w/grf","description":"Arthrodesis, glenohumeral joint; with autogenous graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1084.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92511","name":"Nasopharyngoscopy","description":"Nasopharyngoscopy with endoscope (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70310","name":"X-ray exam of teeth","description":"Radiologic examination, teeth; partial examination, less than full mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1725","name":"Cath, translumin non-laser","description":"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":364.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99342","name":"Home/res vst new low mdm 30","description":"Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57295","name":"Revise vag graft via vagina","description":"Revision (including removal) of prosthetic vaginal graft; vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82382","name":"Assay urine catecholamines","description":"Catecholamines; total urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1190","name":"Wheelchair amputee w/ leg re","description":"Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6884","name":"Replc sockt above elbow disa","description":"Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27198","name":"Clsd tx pelvic ring fx","description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; with ma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0666","name":"Pneumatic appliance half leg","description":"Non-segmental pneumatic appliance for use with pneumatic compressor, half leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88334","name":"Path consltj surg cyto xm ea","description":"Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55530","name":"Revise spermatic cord veins","description":"Excision of varicocele or ligation of spermatic veins for varicocele; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77002","name":"Needle localization by xray","description":"Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88346","name":"Imfluor 1st 1antb stain px","description":"Immunofluorescence, per specimen; initial single antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11404","name":"Exc tr-ext b9+marg 3.1-4 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2330","name":"Lacer molded to patient mode","description":"Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73070","name":"X-ray exam of elbow","description":"Radiologic examination, elbow; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6233","name":"Hydrogel dressing >48 sq in","description":"Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54408","name":"Repair multi-comp penis pros","description":"Repair of component(s) of a multi-component, inflatable penile prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99191","name":"Special pump services","description":"Assembly and operation of pump with oxygenator or heat exchanger (with or without ecg and/or pressure monitoring); 45 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35636","name":"Bpg splenorenal","description":"Bypass graft, with other than vein; splenorenal (splenic to renal arterial anastomosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31536","name":"Laryngoscopy w/bx & op scope","description":"Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36261","name":"Revision of infusion pump","description":"Revision of implanted intra-arterial infusion pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58553","name":"Laparo-vag hyst complex","description":"Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22522","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11644","name":"Exc f/e/e/n/l mal+mrg 3.1-4","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25575","name":"Optx rdl&uln shft fx rds&uln","description":"Open treatment of radial and ulnar shaft fractures, with internal fixation, when performed; of radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":758.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43278","name":"Ercp lesion ablate w/dilate","description":"Endoscopic retrograde cholangiopancreatography (ercp); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82657","name":"Enzyme cell activity","description":"Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76776","name":"Us exam k transpl w/doppler","description":"Ultrasound, transplanted kidney, real time and duplex doppler with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75872","name":"Vein x-ray skull epidural","description":"Venography, epidural, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4719","name":"Y set tubing","description":"Y set tubing for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15120","name":"Splt agrft f/s/n/h/f/g/m 1st","description":"Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2132","name":"Kafo femoral fx cast soft","description":"Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70030","name":"X-ray eye for foreign body","description":"Radiologic examination, eye, for detection of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91122","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9275","name":"Disp home glucose monitor","description":"Home glucose disposable monitor, includes test strips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15156","name":"Tis clt agrft f/s/n/h/f/g ad","description":"Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 75 sq cm (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0550","name":"Humidif extens supple w ippb","description":"Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87477","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87187","name":"Sc std microdil/agar mlc","description":"Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (mlc), each plate (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7032","name":"Replacement nasal cushion","description":"Cushion for use on nasal mask interface, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63305","name":"Remove vert idrl body thrc","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2296.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58553","name":"Laparo-vag hyst complex","description":"Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":723.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28800","name":"Amputation of midfoot","description":"Amputation, foot; midtarsal (eg, chopart type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62220","name":"Establish brain cavity shunt","description":"Creation of shunt; ventriculo-atrial, -jugular, -auricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":888.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98972","name":"Nqhp ol dig assmt&mgmt 21+","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69100","name":"Biopsy of external ear","description":"Biopsy external ear","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2526","name":"Th/wght bear nar m-l brim cu","description":"Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67570","name":"Decompress optic nerve","description":"Optic nerve decompression (eg, incision or fenestration of optic nerve sheath)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57520","name":"Conization of cervix","description":"Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2170","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4262.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27726","name":"Repair fibula nonunion","description":"Repair of fibula nonunion and/or malunion with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":805.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93307","name":"Tte w/o doppler complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87449","name":"Nos each organism ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; not otherwise specified, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3070","name":"Arch suprt att to sho longit","description":"Foot, arch support, non-removable attached to shoe, longitudinal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86741","name":"Neisseria meningitidis","description":"Antibody; neisseria meningitidis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59300","name":"Episiotomy or vaginal repair","description":"Episiotomy or vaginal repair, by other than attending","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25215","name":"Removal of wrist bones","description":"Carpectomy; all bones of proximal row","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":515.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23210","name":"Radical rescj tumor scapula","description":"Radical resection of tumor; scapula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1505.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67420","name":"Explore/treat eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); with removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1014.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0437T","name":"Impltj synth rnfcmt abdl wal","description":"Implantation of non-biologic or synthetic implant (eg, polypropylene) for fascial reinforcement of the abdominal wall (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53415","name":"Reconstruction of urethra","description":"Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87906","name":"Nfct agt gntyp alys hiv1","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); hiv-1, other region (eg, integrase, fusion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27350","name":"Removal of kneecap","description":"Patellectomy or hemipatellectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":549.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00537","name":"Anes cardiac ep procedures","description":"Anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49419","name":"Insert tun ip cath w/port","description":"Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55500","name":"Removal of hydrocele","description":"Excision of hydrocele of spermatic cord, unilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82705","name":"Fats/lipids feces qual","description":"Fat or lipids, feces; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20150","name":"Excision epiphyseal bar","description":"Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through same fascial incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":851.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69970","name":"Remove inner ear lesion","description":"Removal of tumor, temporal bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1729.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52001","name":"Cysto w/irrg&evac mlt clots","description":"Cystourethroscopy with irrigation and evacuation of multiple obstructing clots","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0082","name":"Care man h v ext pt 30 m","description":"Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5698","name":"Ak/knee disartic silesian ba","description":"Addition to lower extremity, above knee or knee disarticulation, silesian bandage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28705","name":"Arthrodesis pantalar","description":"Arthrodesis; pantalar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1012.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77370","name":"Radiation physics consult","description":"Special medical radiation physics consultation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22818","name":"Kyphectomy 1-2 segments","description":"Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87809","name":"Adenovirus assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; adenovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41145","name":"Tongue removal neck surgery","description":"Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98926","name":"Osteopath manj 3-4 regions","description":"Osteopathic manipulative treatment (omt); 3-4 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33948","name":"Ecmo/ecls daily mgmt-venous","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; daily management, each day, veno-venous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29058","name":"Appl cast plaster velpeau","description":"Application, cast; plaster velpeau","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15822","name":"Blepharoplasty upper eyelid","description":"Blepharoplasty, upper eyelid;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63273","name":"Excise intrspinl lesion scrl","description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1706.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0144","name":"Enclosed walker w rear seat","description":"Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76100","name":"X-ray exam of body section","description":"Radiologic examination, single plane body section (eg, tomography), other than with urography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82585","name":"Assay of cryofibrinogen","description":"Cryofibrinogen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82787","name":"Igg 1 2 3 or 4 each","description":"Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, igg1, 2, 3, or 4), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27477","name":"Surgery to stop leg growth","description":"Arrest, epiphyseal, any method (eg, epiphysiodesis); tibia and fibula, proximal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":618.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97760","name":"Orthotic mgmt&traing 1st enc","description":"Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83789","name":"Mass spectrometry qual/quan","description":"Mass spectrometry and tandem mass spectrometry (eg, ms, ms/ms, maldi, ms-tof, qtof), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86638","name":"Q fever antibody","description":"Antibody; coxiella burnetii (q fever)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67450","name":"Explore/biopsy eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); for exploration, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":799.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92562","name":"Loudness balance test","description":"Loudness balance test, alternate binaural or monaural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4725","name":"Dialys sol fld vol > 4999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54650","name":"Orchiopexy (fowler-stephens)","description":"Orchiopexy, abdominal approach, for intra-abdominal testis (eg, fowler-stephens)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":576.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67318","name":"Revise eye muscle(s)","description":"Strabismus surgery, any procedure, superior oblique muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":424.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68130","name":"Exc les conjunctiva adj scl","description":"Excision of lesion, conjunctiva; with adjacent sclera","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":332.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19370","name":"Revj peri-implt capsule brst","description":"Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86612","name":"Blastomyces antibody","description":"Antibody; blastomyces","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33225","name":"L ventric pacing lead add-on","description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31820","name":"Closure of windpipe lesion","description":"Surgical closure tracheostomy or fistula; without plastic repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":326.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63196","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1627.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15836","name":"Exc excessive skin arm","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28735","name":"Fusion of foot bones","description":"Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (eg, flatfoot correction)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87210","name":"Smear wet mount saline/ink","description":"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, india ink, koh preps)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4770","name":"Blood collection tube/vacuum","description":"Blood collection tube, vacuum, for dialysis, per 50","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58951","name":"Resect ovarian malignancy","description":"Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99291","name":"Critical care first hour","description":"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83896","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53210","name":"Removal of urethra","description":"Urethrectomy, total, including cystostomy; female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22110","name":"Remove part of neck vertebra","description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74470","name":"X-ray exam of kidney lesion","description":"Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93979","name":"Vascular study","description":"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97762","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96570","name":"Photodynmc tx 30 min add-on","description":"Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes (list separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88167","name":"Cytopath tbs c/v select","description":"Cytopathology, slides, cervical or vaginal (the bethesda system); with manual screening and computer-assisted rescreening using cell selection and review under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7010","name":"Disposable corrugated tubing","description":"Corrugated tubing, disposable, used with large volume nebulizer, 100 feet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87526","name":"Hepatitis g dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis g, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32810","name":"Close chest after drainage","description":"Closure of chest wall following open flap drainage for empyema (clagett type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35246","name":"Rpr blvsl vn grf ntrthrc w/o","description":"Repair blood vessel with vein graft; intrathoracic, without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0255","name":"Hospital bed var ht w/ mattr","description":"Hospital bed, variable height, hi-lo, with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34510","name":"Transposition of vein valve","description":"Venous valve transposition, any vein donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97598","name":"Dbrdmt opn wnd addl 20cm/<","description":"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when perform","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80402","name":"Acth stimulation panel","description":"Acth stimulation panel; for 21 hydroxylase deficiency this panel must include the following: cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00918","name":"Anes trurl px urtrl cal rmvl","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); with fragmentation, manipulation and/or removal of ureteral calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64413","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0492","name":"Emr pwr cbl elec vad, rep","description":"Emergency power supply cable for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33315","name":"Exploratory heart surgery","description":"Cardiotomy, exploratory (includes removal of foreign body, atrial or ventricular thrombus); with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1662.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99191","name":"Special pump services","description":"Assembly and operation of pump with oxygenator or heat exchanger (with or without ecg and/or pressure monitoring); 45 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67400","name":"Explore/biopsy eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":594.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2086","name":"Off base opioid tx 70min","description":"Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00212","name":"Anes icr px subdural taps","description":"Anesthesia for intracranial procedures; subdural taps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4320","name":"Irrigation tray","description":"Irrigation tray with bulb or piston syringe, any purpose","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65205","name":"Remove foreign body from eye","description":"Removal of foreign body, external eye; conjunctival superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76390","name":"Mr spectroscopy","description":"Magnetic resonance spectroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0330T","name":"Tear film img uni/bi w/i&r","description":"Tear film imaging, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86157","name":"Cold agglutinin titer","description":"Cold agglutinin; titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78802","name":"Rp loclzj tum whbdy 1 d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2627","name":"Plastic mold recipro hip & c","description":"Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":971.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82040","name":"Assay of serum albumin","description":"Albumin; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0051","name":"Cam rel asm ft/legrst rep ea","description":"Cam release assembly, footrest or legrest, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37191","name":"Ins endovas vena cava filtr","description":"Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1937.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87512","name":"Gardner vag dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); gardnerella vaginalis, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44204","name":"Laparo partial colectomy","description":"Laparoscopy, surgical; colectomy, partial, with anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1263.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32422","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2204","name":"Lens sphcy bifocal 4.00d/2.1","description":"Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24130","name":"Excision radial head","description":"Excision, radial head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43113","name":"Removal of esophagus","description":"Total or near total esophagectomy, with thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34831","name":"Open aortoiliac prosth repr","description":"Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1702.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47552","name":"Biliary endo perq dx w/speci","description":"Biliary endoscopy, percutaneous via t-tube or other tract; diagnostic, with collection of specimen(s) by brushing and/or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86355","name":"B cells total count","description":"B cells, total count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31255","name":"Nsl/sins ndsc w/tot ethmdct","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65426","name":"Removal of eye lesion","description":"Excision or transposition of pterygium; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0244","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61640","name":"Dilate ic vasospasm init","description":"Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51860","name":"Repair of bladder wound","description":"Cystorrhaphy, suture of bladder wound, injury or rupture; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":616.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27846","name":"Treat ankle dislocation","description":"Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31367","name":"Partial removal of larynx","description":"Laryngectomy; subtotal supraglottic, without radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92326","name":"Replacement of contact lens","description":"Replacement of contact lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35700","name":"Reoperation bypass graft","description":"Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24331","name":"Flexor-plasty elbw w/advmnt","description":"Flexor-plasty, elbow (eg, steindler type advancement); with extensor advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":664.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61571","name":"Incise skull for brain wound","description":"Craniectomy or craniotomy; with treatment of penetrating wound of brain","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1822.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64625","name":"Rf abltj nrv nrvtg si jt","description":"Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":398.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87899","name":"Agent nos assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60512","name":"Autotransplant parathyroid","description":"Parathyroid autotransplantation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":207.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99493","name":"Sbsq psyc collab care mgmt","description":"Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required el","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43262","name":"Endo cholangiopancreatograph","description":"Endoscopic retrograde cholangiopancreatography (ercp); with sphincterotomy/papillotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86813","name":"Hla typing a b or c","description":"Hla typing; a, b, or c, multiple antigens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35002","name":"Repair artery rupture neck","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, carotid, subclavian artery, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1002.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32664","name":"Thoracoscopy w/ th nrv exc","description":"Thoracoscopy, surgical; with thoracic sympathectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1753","name":"Cath, intravas ultrasound","description":"Catheter, intravascular ultrasound","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52317","name":"Remove bladder stone","description":"Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33726","name":"Repair pul venous stenosis","description":"Repair of pulmonary venous stenosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1768.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2387","name":"Add le poly knee custom kafo","description":"Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17250","name":"Chem caut of granltj tissue","description":"Chemical cauterization of granulation tissue (ie, proud flesh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98941","name":"Chiropract manj 3-4 regions","description":"Chiropractic manipulative treatment (cmt); spinal, 3-4 regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84295","name":"Assay of serum sodium","description":"Sodium; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8047","name":"Nasal septal prosthesis","description":"Nasal septal prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","KM","95","93","NU","","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58953","name":"Tah rad dissect for debulk","description":"Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1275.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70310","name":"X-ray exam of teeth","description":"Radiologic examination, teeth; partial examination, less than full mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01967","name":"Neuraxl lbr anes vag dlvr","description":"Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20985","name":"Cptr-asst dir ms px","description":"Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21552","name":"Exc neck les sc 3 cm/>","description":"Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29807","name":"Sho arthrs srg rpr slap les","description":"Arthroscopy, shoulder, surgical; repair of slap lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":872.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86830","name":"Hla class i phenotype qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); antibody identification by qualitative panel using complete hla phenotypes, hla class i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28260","name":"Release of midfoot joint","description":"Capsulotomy, midfoot; medial release only (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28666","name":"Treat toe dislocation","description":"Percutaneous skeletal fixation of interphalangeal joint dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21700","name":"Revision of neck muscle","description":"Division of scalenus anticus; without resection of cervical rib","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":312.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0182","name":"Replace pump, alt press pad","description":"Pump for alternating pressure pad, for replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36660","name":"Insertion catheter artery","description":"Catheterization, umbilical artery, newborn, for diagnosis or therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3675","name":"So vest canvas/web pre ots","description":"Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4550","name":"Surgical trays","description":"Surgical trays","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1008","name":"Pwr seat combo pwr shear","description":"Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94005","name":"Home vent mgmt supervision","description":"Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 3","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58542","name":"Lsh w/t/o ut 250 g or less","description":"Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":529.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L9900","name":"O&p supply/accessory/service","description":"Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs l code","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82104","name":"Alpha-1-antitrypsin pheno","description":"Alpha-1-antitrypsin; phenotype","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0813","name":"Pwc gp 1 std port seat/back","description":"Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20838","name":"Replantation foot complete","description":"Replantation, foot, complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63055","name":"Decompress spinal cord thrc","description":"Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1467.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78707","name":"K flow/funct image w/o drug","description":"Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97810","name":"Acup 1/> wo estim 1st 15 min","description":"Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75801","name":"Lymph vessel x-ray arm/leg","description":"Lymphangiography, extremity only, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97012","name":"Mechanical traction therapy","description":"Application of a modality to 1 or more areas; traction, mechanical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20605","name":"Drain/inj joint/bursa w/o us","description":"Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26489","name":"Transplant/graft palm tendon","description":"Transfer or transplant of tendon, palmar; with free tendon graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":789.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95923","name":"Autonomic nrv syst funj test","description":"Testing of autonomic nervous system function; sudomotor, including 1 or more of the following: quantitative sudomotor axon reflex test (qsart), silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62292","name":"Njx chemonucleolysis lmbr","description":"Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":466.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25337","name":"Reconstruct ulna/radioulnar","description":"Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":739.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31200","name":"Removal of ethmoid sinus","description":"Ethmoidectomy; intranasal, anterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":441.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01173","name":"Anes opn rpr fx disrpj plvs","description":"Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31575","name":"Diagnostic laryngoscopy","description":"Laryngoscopy, flexible; diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59412","name":"Antepartum manipulation","description":"External cephalic version, with or without tocolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44605","name":"Repair of bowel lesion","description":"Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1078.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27455","name":"Realignment of knee","description":"Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); before epiphyseal closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":805.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87254","name":"Virus inoculation shell via","description":"Virus isolation; centrifuge enhanced (shell vial) technique, includes identification with immunofluorescence stain, each virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96369","name":"Sc ther infusion up to 1 hr","description":"Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78102","name":"Bone marrow imaging ltd","description":"Bone marrow imaging; limited area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33475","name":"Replacement pulmonary valve","description":"Replacement, pulmonary valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0498","name":"Chemo extend iv infus w/pump","description":"Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4400","name":"Ostomy irrigation set","description":"Ostomy irrigation set","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57106","name":"Vagnc prtl rmvl vag wall","description":"Vaginectomy, partial removal of vaginal wall;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":328.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78816","name":"Pet image w/ct full body","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85007","name":"Bl smear w/diff wbc count","description":"Blood count; blood smear, microscopic examination with manual differential wbc count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85549","name":"Muramidase","description":"Muramidase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11424","name":"Exc h-f-nk-sp b9+marg 3.1-4","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44405","name":"Colonoscopy w/dilation","description":"Colonoscopy through stoma; with transendoscopic balloon dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2384","name":"Pneumatic caster tire","description":"Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50546","name":"Laparoscopic nephrectomy","description":"Laparoscopy, surgical; nephrectomy, including partial ureterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27626","name":"Remove ankle joint lining","description":"Arthrotomy, with synovectomy, ankle; including tenosynovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95920","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01500","name":"Anes px art lower leg nos","description":"Anesthesia for procedures on arteries of lower leg, including bypass graft; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20922","name":"Removal of fascia for graft","description":"Fascia lata graft; by incision and area exposure, complex or sheet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50395","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21336","name":"Open tx septal fx w/wo stabj","description":"Open treatment of nasal septal fracture, with or without stabilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":518.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81439","name":"Hrdtry cardmypy gene panel","description":"Hereditary cardiomyopathy (eg, hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy), genomic sequence analysis panel, must include sequencing of at least 5 cardiomyopathy-related genes (eg, dsg2, mybpc3, myh7, pkp2, ttn)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00870","name":"Anes xtrprtl cystolithotomy","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; cystolithotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64818","name":"Sympathectomy lumbar","description":"Sympathectomy, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0252","name":"Pet imaging initial dx","description":"Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75860","name":"Vein x-ray neck","description":"Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32408","name":"Core ndl bx lng/med perq","description":"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":705.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77067","name":"Scr mammo bi incl cad","description":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33976","name":"Implant ventricular device","description":"Insertion of ventricular assist device; extracorporeal, biventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1385.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01484","name":"Anes opn lw l/a/f oste/ostpl","description":"Anesthesia for open procedures on bones of lower leg, ankle, and foot; osteotomy or osteoplasty of tibia and/or fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65290","name":"Repair of eye socket wound","description":"Repair of wound, extraocular muscle, tendon and/or tenons capsule","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0744","name":"Neuromuscular stim for scoli","description":"Neuromuscular stimulator for scoliosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0182","name":"Hospice care supervision","description":"Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other stu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36522","name":"Photopheresis","description":"Photopheresis, extracorporeal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84080","name":"Assay alkaline phosphatases","description":"Phosphatase, alkaline; isoenzymes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92542","name":"Positional nystagmus test","description":"Positional nystagmus test, minimum of 4 positions, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85280","name":"Clot factor xii hageman","description":"Clotting; factor xii (hageman)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01430","name":"Anes px veins knee&pop nos","description":"Anesthesia for procedures on veins of knee and popliteal area; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43246","name":"Egd place gastrostomy tube","description":"Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0651","name":"Pneum compressor segmental","description":"Pneumatic compressor, segmental home model without calibrated gradient pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28820","name":"Amputation of toe","description":"Amputation, toe; metatarsophalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74280","name":"X-ray xm colon 2cntrst std","description":"Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high density barium and air) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59030","name":"Fetal scalp blood sampling","description":"Fetal scalp blood sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85048","name":"Automated leukocyte count","description":"Blood count; leukocyte (wbc), automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62368","name":"Analyze sp inf pump w/reprog","description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24470","name":"Hemiepiphyseal arrest","description":"Hemiepiphyseal arrest (eg, cubitus varus or valgus, distal humerus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34706","name":"Evasc rpr a-biiliac rpt","description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2026.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0439","name":"Stationary liquid 02","description":"Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52305","name":"Cystoscopy and treatment","description":"Cystourethroscopy; with incision or resection of orifice of bladder diverticulum, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27427","name":"Reconstruction knee","description":"Ligamentous reconstruction (augmentation), knee; extra-articular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90965","name":"Esrd home pt serv p mo 12-19","description":"End-stage renal disease (esrd) related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49083","name":"Abd paracentesis w/imaging","description":"Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85652","name":"Rbc sed rate automated","description":"Sedimentation rate, erythrocyte; automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86756","name":"Respiratory virus antibody","description":"Antibody; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2526","name":"Th/wght bear nar m-l brim cu","description":"Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":319.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43252","name":"Egd optical endomicroscopy","description":"Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0840","name":"Tract frame attach headboard","description":"Traction frame, attached to headboard, cervical traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51570","name":"Removal of bladder","description":"Cystectomy, complete; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1196.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49215","name":"Excise sacral spine tumor","description":"Excision of presacral or sacrococcygeal tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5975","name":"Combo ankle/foot prosthesis","description":"All lower extremity prosthesis, combination single axis ankle and flexible keel foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9481","name":"Remote e/m new pt 10mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history;  a problem focused examination; and straightforward medical decision making, furn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35522","name":"Art byp grft axill-brachial","description":"Bypass graft, with vein; axillary-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1072.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1353","name":"Oxygen supplies regulator","description":"Regulator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88361","name":"Tumor immunohistochem/comput","description":"Morphometric analysis, tumor immunohistochemistry (eg, her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; using computer-assisted technology","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64702","name":"Revise finger/toe nerve","description":"Neuroplasty; digital, 1 or both, same digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":417.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82383","name":"Assay blood catecholamines","description":"Catecholamines; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99325","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24605","name":"Tx clsd elbow dislc req anes","description":"Treatment of closed elbow dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93288","name":"Interrog evl pm/ldls pm ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31654","name":"Bronch ebus ivntj perph les","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (list separately in addition to code for primary procedure[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75571","name":"Ct hrt w/o dye w/ca test","description":"Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0432","name":"Eia hiv-1/hiv-2 screen","description":"Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66682","name":"Repair iris & ciliary body","description":"Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (eg, mccannel suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6535","name":"Gc stocking thighlngth 40+","description":"Gradient compression stocking, thigh length, 40 mmhg or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68811","name":"Probe nasolacrimal duct","description":"Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67025","name":"Replace eye fluid","description":"Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11977","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7008","name":"Disposable nebulizer prefill","description":"Large volume nebulizer, disposable, prefilled, used with aerosol compressor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25375","name":"Revise radius & ulna","description":"Multiple osteotomies, with realignment on intramedullary rod (sofield type procedure); radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35600","name":"Open hrv uxtr art 1 sgm cab","description":"Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":224.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83010","name":"Assay of haptoglobin quant","description":"Haptoglobin; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25120","name":"Removal of forearm lesion","description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9512","name":"Tc99m pertechnetate","description":"Technetium tc-99m pertechnetate, diagnostic, per millicurie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52010","name":"Cystoscopy & duct catheter","description":"Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct radiography, exclusive of radiologic service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26992","name":"Drainage of bone lesion","description":"Incision, bone cortex, pelvis and/or hip joint (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54620","name":"Suspension of testis","description":"Fixation of contralateral testis (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":242.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73721","name":"Mri jnt of lwr extre w/o dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82672","name":"Assay of estrogen","description":"Estrogens; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27326","name":"Neurectomy popliteal","description":"Neurectomy, popliteal (gastrocnemius)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":435.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65860","name":"Severing ads ant sgm laser","description":"Severing adhesions of anterior segment, laser technique (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4556","name":"Electrodes, pair","description":"Electrodes, (e.g., apnea monitor), per pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31527","name":"Laryngoscopy for treatment","description":"Laryngoscopy direct, with or without tracheoscopy; with insertion of obturator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58200","name":"Extensive hysterectomy","description":"Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35601","name":"Bpg com crtd-ipsi int crtd","description":"Bypass graft, with other than vein; common carotid-ipsilateral internal carotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1233.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2218","name":"Foam propulsion tire each","description":"Manual wheelchair accessory, foam propulsion tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80428","name":"Growth hormone panel","description":"Growth hormone stimulation panel (eg, arginine infusion, l-dopa administration) this panel must include the following: human growth hormone (hgh) (83003 x 4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4723","name":"Dialys sol fld vol > 2999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85390","name":"Fibrinolysins screen i&r","description":"Fibrinolysins or coagulopathy screen, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33737","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1124.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15157","name":"Tis clt agrft f/s/n/h/f/g ea","description":"Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1223","name":"Wheelchair spec size w foot","description":"Wheelchair with detachable arms, footrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51727","name":"Cystometrogram w/up","description":"Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95865","name":"Needle emg larynx","description":"Needle electromyography; larynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23156","name":"Removal of humerus lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76800","name":"Us exam spinal canal","description":"Ultrasound, spinal canal and contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00868","name":"Anes xtrprtl px rnl transpl","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal transplant (recipient)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5824","name":"Endo knee-shin fluid swing p","description":"Addition, endoskeletal knee-shin system, single axis, fluid swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":942.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23532","name":"Optx strclv dslc aq/chrn grf","description":"Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81329","name":"Smn1 gene dos/deletion alys","description":"Smn1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; dosage/deletion analysis (eg, carrier testing), includes smn2 (survival of motor neuron 2, centromeric) analysis, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33949","name":"Ecmo/ecls daily mgmt artery","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; daily management, each day, veno-arterial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2038","name":"Kafo w/o joint multi-axis an","description":"Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8001","name":"Breast prosthesis bra & form","description":"Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37788","name":"Revascularization penis","description":"Penile revascularization, artery, with or without vein graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68540","name":"Remove tear gland lesion","description":"Excision of lacrimal gland tumor; frontal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":574.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27760","name":"Cltx medial ankle fx","description":"Closed treatment of medial malleolus fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43842","name":"Gstr rstcv px v-banded gstp","description":"Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":872.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44212","name":"Laparo total proctocolectomy","description":"Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27566","name":"Treat kneecap dislocation","description":"Open treatment of patellar dislocation, with or without partial or total patellectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":756.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0394","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88355","name":"M/phmtrc alys skeletal musc","description":"Morphometric analysis; skeletal muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45905","name":"Dilation of anal sphincter","description":"Dilation of anal sphincter (separate procedure) under anesthesia other than local","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21246","name":"Reconstruction of jaw","description":"Reconstruction of mandible or maxilla, subperiosteal implant; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65275","name":"Repair of eye wound","description":"Repair of laceration; cornea, nonperforating, with or without removal foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22112","name":"Remove part thorax vertebra","description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1011.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B9002","name":"Enter nutr inf pump any type","description":"Enteral nutrition infusion pump, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1685","name":"Post-op hip abduct custom fa","description":"Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6693","name":"Lockingelbow forearm cntrbal","description":"Upper extremity addition, locking elbow, forearm counterbalance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34490","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93317","name":"Echo transesophageal","description":"Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3222","name":"Mens shoes hightop depth inl","description":"Orthopedic footwear, mens shoe, hightop, depth inlay, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8015","name":"Ext breastprosthesis garment","description":"External breast prosthesis garment, with mastectomy form, post mastectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21450","name":"Cltx mndblr fx w/o mnpj","description":"Closed treatment of mandibular fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":462.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33871","name":"Transvrs a-arch grf hypthrm","description":"Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60605","name":"Remove carotid body lesion","description":"Excision of carotid body tumor; with excision of carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88249","name":"Chromosome analysis 100","description":"Chromosome analysis for breakage syndromes; score 100 cells, clastogen stress (eg, diepoxybutane, mitomycin c, ionizing radiation, uv radiation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93260","name":"Prgrmg dev eval impltbl sys","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33031","name":"Partial removal of heart sac","description":"Pericardiectomy, subtotal or complete; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33300","name":"Repair of heart wound","description":"Repair of cardiac wound; without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11400","name":"Exc tr-ext b9+marg 0.5 cm<","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93662","name":"Intracardiac ecg (ice)","description":"Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88233","name":"Tissue culture skin/biopsy","description":"Tissue culture for non-neoplastic disorders; skin or other solid tissue biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7522","name":"Trach/laryn tube stainless","description":"Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4398","name":"Ostomy irrigation bag","description":"Ostomy irrigation supply; bag, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25545","name":"Optx ulnar shft fx int fixj","description":"Open treatment of ulnar shaft fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":521.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96411","name":"Chemo iv push addl drug","description":"Chemotherapy administration; intravenous, push technique, each additional substance/drug (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15750","name":"Neurovascular pedicle flap","description":"Flap; neurovascular pedicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":587.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93226","name":"Xtrnl ecg rec<48 hr scan a/r","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10120","name":"Inc&rmvl fb subq tiss smpl","description":"Incision and removal of foreign body, subcutaneous tissues; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57320","name":"Repair bladder-vagina lesion","description":"Closure of vesicovaginal fistula; vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86900","name":"Blood typing serologic abo","description":"Blood typing, serologic; abo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44206","name":"Lap part colectomy w/stoma","description":"Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (hartmann type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36252","name":"Ins cath ren art 1st bilat","description":"Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and inte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51700","name":"Irrigation of bladder","description":"Bladder irrigation, simple, lavage and/or instillation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46705","name":"Repair of anal stricture","description":"Anoplasty, plastic operation for stricture; infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":464.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49021","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":746.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70160","name":"X-ray exam of nasal bones","description":"Radiologic examination, nasal bones, complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31648","name":"Bronchial valve remov init","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45331","name":"Sigmoidoscopy and biopsy","description":"Sigmoidoscopy, flexible; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":211.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32673","name":"Thoracoscopy w/thymus resect","description":"Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":972.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60281","name":"Remove thyroid duct lesion","description":"Excision of thyroglossal duct cyst or sinus; recurrent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2313","name":"Pwc harness, expand control","description":"Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27052","name":"Biopsy of hip joint","description":"Arthrotomy, with biopsy; hip joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":486.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95909","name":"Nrv cndj tst 5-6 studies","description":"Nerve conduction studies; 5-6 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9282","name":"Wig any type","description":"Wig, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61600","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5241","name":"Dispensing fee, monaural","description":"Dispensing fee, monaural hearing aid, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1940","name":"Afo molded to patient plasti","description":"Ankle foot orthosis, plastic or other material, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90807","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82657","name":"Enzyme cell activity","description":"Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27786","name":"Treatment of ankle fracture","description":"Closed treatment of distal fibular fracture (lateral malleolus); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":259.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99488","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57310","name":"Repair urethrovaginal lesion","description":"Closure of urethrovaginal fistula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15770","name":"Derma-fat-fascia graft","description":"Graft; derma-fat-fascia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86171","name":"Complement fixation each","description":"Complement fixation tests, each antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86723","name":"Listeria monocytogenes","description":"Antibody; listeria monocytogenes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92544","name":"Optokinetic nystagmus test","description":"Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64644","name":"Chemodenerv 1 extrem 5/> mus","description":"Chemodenervation of one extremity; 5 or more muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93261","name":"Interrogate subq defib","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87803","name":"Clostridium toxin a w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; clostridium difficile toxin a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19368","name":"Brst rcnstj 1pdcl tram anast","description":"Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (tram) flap, requiring separate microvascular anastomosis (supercharging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1417.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99234","name":"Hosp ip/obs sm dt sf/low 45","description":"Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. when using total time on the date ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56606","name":"Biopsy of vulva/perineum","description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23140","name":"Removal of bone lesion","description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":466.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31624","name":"Dx bronchoscope/lavage","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95927","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25111","name":"Remove wrist tendon lesion","description":"Excision of ganglion, wrist (dorsal or volar); primary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26740","name":"Treat finger fracture each","description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82525","name":"Assay of copper","description":"Copper","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75896","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":802.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21100","name":"Maxillofacial fixation","description":"Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":532.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86784","name":"Trichinella antibody","description":"Antibody; trichinella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0101","name":"Ca screen;pelvic/breast exam","description":"Cervical or vaginal cancer screening; pelvic and clinical breast examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4035","name":"Enteral feed supp pump per d","description":"Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27788","name":"Treatment of ankle fracture","description":"Closed treatment of distal fibular fracture (lateral malleolus); with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37236","name":"Open/perq place stent 1st","description":"Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1690.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28470","name":"Cltx metatarsal fx wo mnp ea","description":"Closed treatment of metatarsal fracture; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8613","name":"Ossicular implant","description":"Ossicula implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85420","name":"Fibrinolytic plasminogen","description":"Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93924","name":"Lwr xtr vasc stdy bilat","description":"Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional doppler waveform or volume plethysmography recording and analysis at rest with ankle/brachial indices immediately after and at timed intervals following performance of a st","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71045","name":"X-ray exam chest 1 view","description":"Radiologic examination, chest; single view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71101","name":"X-ray exam unilat ribs/chest","description":"Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2115","name":"Lens lenticular bifocal","description":"Lenticular, (myodisc), per lens, single vision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98967","name":"Ph1 assmt&mgmt nqhp 11-20","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73592","name":"X-ray exam of leg infant","description":"Radiologic examination; lower extremity, infant, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76519","name":"Echo exam of eye","description":"Ophthalmic biometry by ultrasound echography, a-scan; with intraocular lens power calculation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85345","name":"Coagulation time lee & white","description":"Coagulation time; lee and white","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4595","name":"Tens suppl 2 lead per month","description":"Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32220","name":"Release of lung","description":"Decortication, pulmonary (separate procedure); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1267.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35633","name":"Bpg ilio-mesenteric","description":"Bypass graft, with other than vein; ilio-mesenteric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01952","name":"Anes 2&3 burn 4-9% tbsa","description":"Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (tbsa) treated during anesthesia and surgery; between 4% and 9% of total body surface area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24410","name":"Mlt osteot rlgnm imed rd hum","description":"Multiple osteotomies with realignment on intramedullary rod, humeral shaft (sofield type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92633","name":"Aud rehab postling hear loss","description":"Auditory rehabilitation; postlingual hearing loss","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7507","name":"Integrated filter & holder","description":"Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7520","name":"Trach/laryn tube non-cuffed","description":"Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73218","name":"Mri upper extremity w/o dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88161","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; preparation, screening and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3590","name":"O shoe convert to sof counte","description":"Orthopedic shoe addition, convert firm shoe counter to soft counter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64763","name":"Incise hip/thigh nerve","description":"Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5680","name":"Bk thigh lacer non-molded","description":"Addition to lower extremity, below knee, thigh lacer, nonmolded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31296","name":"Nsl/sins ndsc surg frnt sins","description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1426.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31624","name":"Dx bronchoscope/lavage","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30915","name":"Ligation nasal sinus artery","description":"Ligation arteries; ethmoidal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4211","name":"Supp for self-adm injections","description":"Supplies for self-administered injections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80047","name":"Basic metablc pnl ionized ca","description":"Basic metabolic panel (calcium, ionized) this panel must include the following: calcium, ionized (82330) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) potassium (84132) sodium (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70482","name":"Ct orbit/ear/fossa w/o&w/dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27724","name":"Repair/graft of tibia","description":"Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31630","name":"Bronchoscopy dilate/fx repr","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32661","name":"Thoracoscopy w/pericard exc","description":"Thoracoscopy, surgical; with excision of pericardial cyst, tumor, or mass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67005","name":"Partial removal of eye fluid","description":"Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":284.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1907","name":"Afo supramalleolar custom","description":"Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66710","name":"Ciliary transsleral therapy","description":"Ciliary body destruction; cyclophotocoagulation, transscleral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50830","name":"Revise urine flow","description":"Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1457.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01500","name":"Anes px art lower leg nos","description":"Anesthesia for procedures on arteries of lower leg, including bypass graft; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37229","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5661.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17273","name":"Dstr mal les s/n/h/f/g 2.1-3","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0421","name":"Ed svc ckd grp per session","description":"Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33234","name":"Removal of pacemaker system","description":"Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84066","name":"Assay prostate phosphatase","description":"Phosphatase, acid; prostatic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30520","name":"Repair of nasal septum","description":"Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":484.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87267","name":"Enterovirus antibody dfa","description":"Infectious agent antigen detection by immunofluorescent technique; enterovirus, direct fluorescent antibody (dfa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0014","name":"Alcohol and/or drug services","description":"Alcohol and/or drug services; ambulatory detoxification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27060","name":"Removal of ischial bursa","description":"Excision; ischial bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1768","name":"Graft, vascular","description":"Graft, vascular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64912","name":"Nrv rpr w/nrv algrft 1st","description":"Nerve repair; with nerve allograft, each nerve, first strand (cable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43331","name":"Esophagomyotomy thoracic","description":"Esophagomyotomy (heller type); thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43754","name":"Dx gastr intub w/asp spec","description":"Gastric intubation and aspiration, diagnostic; single specimen (eg, acid analysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31647","name":"Bronchial valve init insert","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78469","name":"Heart infarct image (3d)","description":"Myocardial imaging, infarct avid, planar; tomographic spect with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59525","name":"Remove uterus after cesarean","description":"Subtotal or total hysterectomy after cesarean delivery (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72198","name":"Mr angio pelvis w/o & w/dye","description":"Magnetic resonance angiography, pelvis, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86592","name":"Syphilis test non-trep qual","description":"Syphilis test, non-treponemal antibody; qualitative (eg, vdrl, rpr, art)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81025","name":"Urine pregnancy test","description":"Urine pregnancy test, by visual color comparison methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5595","name":"Hip disartic sach thermopls","description":"Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2205.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33130","name":"Rescj external cardiac tumor","description":"Resection of external cardiac tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1184.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57210","name":"Repair vagina/perineum","description":"Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44955","name":"Appendectomy add-on","description":"Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5083","name":"Stoma absorptive cover","description":"Continent device, stoma absorptive cover for continent stoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01953","name":"Anes 2&3 burn ea add 9% tbsa","description":"Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (tbsa) treated during anesthesia and surgery; each additional 9% total body surface area or part thereof (list separately in addition to code for primary procedur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22116","name":"Remove extra spine segment","description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88240","name":"Cell cryopreserve/storage","description":"Cryopreservation, freezing and storage of cells, each cell line","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84150","name":"Assay of prostaglandin","description":"Prostaglandin, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20827","name":"Replantation thumb complete","description":"Replantation, thumb (includes distal tip to mp joint), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1544.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27232","name":"Treat thigh fracture","description":"Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84207","name":"Assay of vitamin b-6","description":"Pyridoxal phosphate (vitamin b-6)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61557","name":"Incise skull/sutures","description":"Craniotomy for craniosynostosis; bifrontal bone flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78483","name":"Heart first pass multiple","description":"Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0580","name":"Nebulizer for use w/ regulat","description":"Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0451","name":"Devlopment test interpt&rep","description":"Development testing, with interpretation and report, per standardized instrument form","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2623","name":"Adj skin pro wc cus wd>=22in","description":"Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35390","name":"Reoperation carotid add-on","description":"Reoperation, carotid, thromboendarterectomy, more than 1 month after original operation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0064A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95908","name":"Nrv cndj tst 3-4 studies","description":"Nerve conduction studies; 3-4 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86386","name":"Nuclear matrix protein 22","description":"Nuclear matrix protein 22 (nmp22), qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7402","name":"Add ue prost s/d ultlite mat","description":"Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27720","name":"Repair of tibia","description":"Repair of nonunion or malunion, tibia; without graft, (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":737.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47560","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":218.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78608","name":"Brain imaging (pet)","description":"Brain imaging, positron emission tomography (pet); metabolic evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97014","name":"Electric stimulation therapy","description":"Application of a modality to 1 or more areas; electrical stimulation (unattended)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78458","name":"Ven thrombosis images bilat","description":"Venous thrombosis imaging, venogram; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82575","name":"Creatinine clearance test","description":"Creatinine; clearance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21085","name":"Impres&prep oral surg splint","description":"Impression and custom preparation; oral surgical splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25922","name":"Amputate hand at wrist","description":"Disarticulation through wrist; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87502","name":"Influenza dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1029","name":"W/c vent tray fixed","description":"Wheelchair accessory, ventilator tray, fixed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8421","name":"Ready gradient sleev/glov","description":"Gradient pressure aid (sleeve and glove combination), ready made","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41820","name":"Excision gum each quadrant","description":"Gingivectomy, excision gingiva, each quadrant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":133.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20975","name":"Estim aid bone healg invasiv","description":"Electrical stimulation to aid bone healing; invasive (operative)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37609","name":"Ligation/bx temporal artery","description":"Ligation or biopsy, temporal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":260.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70543","name":"Mri orbt/fac/nck w/o &w/dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":306.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43752","name":"Nasal/orogastric w/tube plmt","description":"Naso- or oro-gastric tube placement, requiring physicians skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62272","name":"Ther spi pnxr drg csf","description":"Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20500","name":"Njx sinus tract therapeutic","description":"Injection of sinus tract; therapeutic (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0814","name":"Pwc gp 1 std port cap chair","description":"Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11642","name":"Exc f/e/e/n/l mal+mrg 1.1-2","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63050","name":"Cervical laminoplsty 2/> seg","description":"Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4382","name":"Urinary hvy plstc pch w/o fp","description":"Ostomy pouch, urinary, for use on faceplate, heavy plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20701","name":"Rmvl deep rx delivery device","description":"Removal of drug-delivery device(s), deep (eg, subfascial) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27816","name":"Treatment of ankle fracture","description":"Closed treatment of trimalleolar ankle fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69643","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88230","name":"Tissue culture lymphocyte","description":"Tissue culture for non-neoplastic disorders; lymphocyte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63003","name":"Remove spine lamina 1/2 thrc","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1109.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32553","name":"Ins mark thor for rt perq","description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73201","name":"Ct upper extremity w/dye","description":"Computed tomography, upper extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71047","name":"X-ray exam chest 3 views","description":"Radiologic examination, chest; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33422","name":"Revision of mitral valve","description":"Valvotomy, mitral valve; open heart, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1443.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51940","name":"Correction of bladder defect","description":"Closure, exstrophy of bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1326.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25332","name":"Revise wrist joint","description":"Arthroplasty, wrist, with or without interposition, with or without external or internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98927","name":"Osteopath manj 5-6 regions","description":"Osteopathic manipulative treatment (omt); 5-6 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97140","name":"Manual therapy 1/> regions","description":"Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58956","name":"Bso omentectomy w/tah","description":"Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":867.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93041","name":"Rhythm ecg tracing","description":"Rhythm ecg, 1-3 leads; tracing only without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50548","name":"Laparo remove w/ureter","description":"Laparoscopy, surgical; nephrectomy with total ureterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1089.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53040","name":"Drainage of urethra abscess","description":"Drainage of deep periurethral abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57530","name":"Removal of cervix","description":"Trachelectomy (cervicectomy), amputation of cervix (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":230.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74450","name":"X-ray urethra/bladder","description":"Urethrocystography, retrograde, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92601","name":"Cochlear implt f/up exam <7","description":"Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54164","name":"Frenulotomy of penis","description":"Frenulotomy of penis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01656","name":"Anes art sho&ax ax-fem bpg","description":"Anesthesia for procedures on arteries of shoulder and axilla; axillary-femoral bypass graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67220","name":"Treatment of choroid lesion","description":"Destruction of localized lesion of choroid (eg, choroidal neovascularization); photocoagulation (eg, laser), 1 or more sessions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85250","name":"Clot factor ix ptc/chrstmas","description":"Clotting; factor ix (ptc or christmas)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93603","name":"Right ventricular recording","description":"Right ventricular recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73510","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0201T","name":"Perq sacral augmt bilat inj","description":"Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1513.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85670","name":"Thrombin time plasma","description":"Thrombin time; plasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93454","name":"Coronary artery angio s&i","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0245","name":"Initial foot exam pt lops","description":"Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99493","name":"Sbsq psyc collab care mgmt","description":"Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required el","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00104","name":"Anes electroconvulsive ther","description":"Anesthesia for electroconvulsive therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8600","name":"Implant breast silicone/eq","description":"Implantable breast prosthesis, silicone or equal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58943","name":"Removal of ovary(s)","description":"Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy(s), with or without omentectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":745.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78266","name":"Gstr empt img sm bwl&colon","description":"Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33478","name":"Revision of heart chamber","description":"Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1363.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92542","name":"Positional nystagmus test","description":"Positional nystagmus test, minimum of 4 positions, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0434","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81172","name":"Aff2 gen alys charac alleles","description":"Aff2 (alf transcription elongation factor 2 [fmr2]) (eg, fragile x intellectual disability 2 [fraxe]) gene analysis; characterization of alleles (eg, expanded size and methylation status)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93653","name":"Compre ep eval tx svt","description":"Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensiona","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35246","name":"Rpr blvsl vn grf ntrthrc w/o","description":"Repair blood vessel with vein graft; intrathoracic, without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1357.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70300","name":"X-ray exam of teeth","description":"Radiologic examination, teeth; single view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42900","name":"Repair throat wound","description":"Suture pharynx for wound or injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5714","name":"Knee-shin exo variable frict","description":"Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36597","name":"Reposition venous catheter","description":"Repositioning of previously placed central venous catheter under fluoroscopic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3915","name":"Who nontorsion jnts pre cst","description":"Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76870","name":"Us exam scrotum","description":"Ultrasound, scrotum and contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31633","name":"Bronchoscopy/needle bx addl","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58145","name":"Myomectomy vag method","description":"Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80424","name":"Glucagon tolerance panel","description":"Glucagon tolerance panel; for pheochromocytoma this panel must include the following: catecholamines, fractionated (82384 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75810","name":"Vein x-ray spleen/liver","description":"Splenoportography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":493.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6250","name":"Skin seal protect moisturizr","description":"Skin sealants, protectants, moisturizers, ointments, any type, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42960","name":"Control throat bleeding","description":"Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71047","name":"X-ray exam chest 3 views","description":"Radiologic examination, chest; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2620","name":"Pelvic control hip heavy dut","description":"Addition to lower extremity, pelvic control, hip joint, heavy duty, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71250","name":"Ct thorax dx c-","description":"Computed tomography, thorax, diagnostic; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26123","name":"Release palm contracture","description":"Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97597","name":"Dbrdmt opn wnd 1st 20 cm/<","description":"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when perform","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64418","name":"Njx aa&/strd sprscap nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; suprascapular nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84260","name":"Assay of serotonin","description":"Serotonin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28345","name":"Repair webbed toe(s)","description":"Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":416.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84105","name":"Assay of urine phosphorus","description":"Phosphorus inorganic (phosphate); urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72265","name":"Myelography l-s spine","description":"Myelography, lumbosacral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0222T","name":"Plmt post facet implt addl","description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73725","name":"Mr ang lwr ext w or w/o dye","description":"Magnetic resonance angiography, lower extremity, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80069","name":"Renal function panel","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 (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41800","name":"Drainage of gum lesion","description":"Drainage of abscess, cyst, hematoma from dentoalveolar structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":228.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93975","name":"Vascular study","description":"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27071","name":"Part removal hip bone deep","description":"Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84512","name":"Assay of troponin qual","description":"Troponin, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63660","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":321.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51792","name":"Urinary reflex study","description":"Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98960","name":"Edu&trn pt self-mgmt nqhp 1","description":"Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31276","name":"Nsl/sins ndsc frnt tiss rmvl","description":"Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":284.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64435","name":"Njx aa&/strd paracrv nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; paracervical (uterine) nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0986","name":"Man w/c powr assist syst","description":"Manual wheelchair accessory, power assist system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35509","name":"Art byp grft contral carotid","description":"Bypass graft, with vein; carotid-contralateral carotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27176","name":"Treat slipped epiphysis","description":"Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":777.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92316","name":"C-lens fitg tech aphakia ou","description":"Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, both eyes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78014","name":"Thyroid imaging w/blood flow","description":"Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32657","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":619.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52352","name":"Cystouretero w/stone remove","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74775","name":"X-ray exam of perineum","description":"Perineogram (eg, vaginogram, for sex determination or extent of anomalies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85175","name":"Blood clot lysis time","description":"Clot lysis time, whole blood dilution","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4531","name":"Ped size pull-on sm/med","description":"Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6532","name":"Compress stking bk40-50 surg","description":"Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["AW","GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2114","name":"Afo tib fx semi-rigid","description":"Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99328","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28476","name":"Prq skel fix metar fx w/mnpj","description":"Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":302.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73600","name":"X-ray exam of ankle","description":"Radiologic examination, ankle; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31786","name":"Remove windpipe lesion","description":"Excision of tracheal tumor or carcinoma; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29582","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94013","name":"Meas lung vol thru 2 yrs","description":"Measurement of lung volumes (ie, functional residual capacity [frc], forced vital capacity [fvc], and expiratory reserve volume [erv]) in an infant or child through 2 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69310","name":"Rebuild outer ear canal","description":"Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to injury, infection) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":882.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72050","name":"X-ray exam neck spine 4/5vws","description":"Radiologic examination, spine, cervical; 4 or 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2768","name":"Ortho sidebar disconnect","description":"Orthotic side bar disconnect device, per bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6388","name":"Postop applicat rigid dsg on","description":"Immediate post surgical or early fitting, application of rigid dressing only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29877","name":"Arthrs knee surg dbrdmt/shvg","description":"Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40842","name":"Reconstruction of mouth","description":"Vestibuloplasty; posterior, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":720.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8682","name":"Implt neurostim radiofq rec","description":"Implantable neurostimulator radiofrequency receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36560","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1083.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42106","name":"Excision lesion mouth roof","description":"Excision, lesion of palate, uvula; with simple primary closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86148","name":"Anti-phospholipid antibody","description":"Anti-phosphatidylserine (phospholipid) antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24330","name":"Flexor-plasty elbow","description":"Flexor-plasty, elbow (eg, steindler type advancement);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1015","name":"Shock absorber for man w/c","description":"Shock absorber for manual wheelchair, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88148","name":"Cytopath c/v auto rescreen","description":"Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25491","name":"Prophylactic tx ulna","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2201","name":"Man w/ch acc seat w>=20in<24in","description":"Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90833","name":"Psytx w pt w e/m 30 min","description":"Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57800","name":"Dilation of cervical canal","description":"Dilation of cervical canal, instrumental (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97814","name":"Acup 1/> w/estim ea addl 15","description":"Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with insertion of needle(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96002","name":"Dynamic surface emg","description":"Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94003","name":"Vent mgmt inpat subq day","description":"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, each subsequent day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87582","name":"M.pneumon dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); mycoplasma pneumoniae, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82725","name":"Assay of blood fatty acids","description":"Fatty acids, nonesterified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92225","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36217","name":"Place catheter in artery","description":"Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65150","name":"Revise ocular implant","description":"Reinsertion of ocular implant; with or without conjunctival graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74440","name":"X-ray male genital tract","description":"Vasography, vesiculography, or epididymography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77066","name":"Dx mammo incl cad bi","description":"Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":133.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89135","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90935","name":"Hemodialysis one evaluation","description":"Hemodialysis procedure with single evaluation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93600","name":"Bundle of his recording","description":"Bundle of his recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99385","name":"Prev visit new age 18-39","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6382","name":"Postop dsg cast chg elb dis/","description":"Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0421T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":611.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99423","name":"Ol dig e/m svc 21+ min","description":"Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15572","name":"Skin pedicle flap arms/legs","description":"Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":560.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87077","name":"Culture aerobic identify","description":"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27236","name":"Treat thigh fracture","description":"Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73219","name":"Mri upper extremity w/dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6120","name":"Elbow mold doub splt soc ste","description":"Below elbow, molded double wall split socket, step-up hinges, half cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1467.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27325","name":"Neurectomy hamstring","description":"Neurectomy, hamstring muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25071","name":"Exc forearm les sc 3 cm/>","description":"Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86255","name":"Fluorescent antibody screen","description":"Fluorescent noninfectious agent antibody; screen, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33213","name":"Insert pulse gen dual leads","description":"Insertion of pacemaker pulse generator only; with existing dual leads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95857","name":"Cholinesterase challenge","description":"Cholinesterase inhibitor challenge test for myasthenia gravis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25651","name":"Perq skel fix ulnar styld fx","description":"Percutaneous skeletal fixation of ulnar styloid fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":407.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65755","name":"Corneal transplant","description":"Keratoplasty (corneal transplant); penetrating (in pseudophakia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":748.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87451","name":"Polyvalent mult org ea ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; polyvalent for multiple organisms, each polyvalent antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25370","name":"Revise radius or ulna","description":"Multiple osteotomies, with realignment on intramedullary rod (sofield type procedure); radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":853.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74251","name":"X-ray xm sm int 2cntrst std","description":"Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33426","name":"Repair of mitral valve","description":"Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86821","name":"Lymphocyte culture mixed","description":"Hla typing; lymphocyte culture, mixed (mlc)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92132","name":"Cptrzd oph dx img ant sgm","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), anterior segment, with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61798","name":"Srs cranial lesion complex","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 complex cranial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1256.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63191","name":"Incise spine accessory nerve","description":"Laminectomy with section of spinal accessory nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1255.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28436","name":"Prq skel fix talus fx w/mnpj","description":"Percutaneous skeletal fixation of talus fracture, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2762","name":"Polarization, any lens","description":"Polarization, any lens material, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78433","name":"Myocrd img pet 2rtracer ct","description":"Myocardial imaging, positron emission tomography (pet), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2251.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19081","name":"Bx breast 1st lesion strtctc","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27826","name":"Treat lower leg fracture","description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6810","name":"Term dev precision pinch dev","description":"Addition to terminal device, precision pinch device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5055","name":"Stoma cap","description":"Stoma cap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88350","name":"Imfluor ea addl 1antb stn px","description":"Immunofluorescence, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59012","name":"Fetal cord puncture prenatal","description":"Cordocentesis (intrauterine), any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5341","name":"Hemipelvectomy canadian sach","description":"Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2526.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63057","name":"Decompress spine cord add-on","description":"Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36596","name":"Mech remov tunneled cv cath","description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83721","name":"Assay of blood lipoprotein","description":"Lipoprotein, direct measurement; ldl cholesterol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32098","name":"Open biopsy of lung pleura","description":"Thoracotomy, with biopsy(ies) of pleura","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95718","name":"Eeg phys/qhp 2-12 hr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report, 2-12 hours of eeg recording; with video (veeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0816","name":"Pwc gp 1 std cap chair","description":"Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33606","name":"Anastomosis/artery-aorta","description":"Anastomosis of pulmonary artery to aorta (damus-kaye-stansel procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1544.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31002","name":"Irrigation sphenoid sinus","description":"Lavage by cannulation; sphenoid sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93316","name":"Echo transesophageal","description":"Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41530","name":"Tongue base vol reduction","description":"Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":736.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93980","name":"Penile vascular study","description":"Duplex scan of arterial inflow and venous outflow of penile vessels; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97112","name":"Neuromuscular reeducation","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53448","name":"Remov/replc ur sphinctr comp","description":"Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff through an infected field at the same operative session including irrigation and debridement of infected tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1035.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86612","name":"Blastomyces antibody","description":"Antibody; blastomyces","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21348","name":"Opn tx nasomax fx w/graft","description":"Open treatment of nasomaxillary complex fracture (lefort ii type); with bone grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84234","name":"Assay of progesterone","description":"Receptor assay; progesterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43631","name":"Removal of stomach partial","description":"Gastrectomy, partial, distal; with gastroduodenostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1211.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25810","name":"Arthrd wrst iliac/oth agrft","description":"Arthrodesis, wrist; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72190","name":"X-ray exam of pelvis","description":"Radiologic examination, pelvis; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72265","name":"Myelography l-s spine","description":"Myelography, lumbosacral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74221","name":"X-ray xm esophagus 2cntrst","description":"Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31660","name":"Bronch thermoplsty 1 lobe","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96136","name":"Psycl/nrpsyc tst phy/qhp 1st","description":"Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0424","name":"Stationary compressed gas 02","description":"Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35526","name":"Art byp grft aor/carot/innom","description":"Bypass graft, with vein; aortosubclavian, aortoinnominate, or aortocarotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1504.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73520","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87472","name":"Bartonella dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); bartonella henselae and bartonella quintana, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61782","name":"Scan proc cranial extra","description":"Stereotactic computer-assisted (navigational) procedure; cranial, extradural (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73542","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33786","name":"Repair arterial trunk","description":"Total repair, truncus arteriosus (rastelli type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21453","name":"Cltx mndblr fx ntrdntl fixj","description":"Closed treatment of mandibular fracture with interdental fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":814.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95117","name":"Immunotherapy injections","description":"Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61542","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1721.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69635","name":"Repair eardrum structures","description":"Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96420","name":"Chemo ia push tecnique","description":"Chemotherapy administration, intra-arterial; push technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20101","name":"Expl pentrg wound chest","description":"Exploration of penetrating wound (separate procedure); chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":400.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6200","name":"Elbow mold outsid lock hinge","description":"Elbow disarticulation, molded socket, outside locking hinge, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1353.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6266","name":"Impreg gauze no h20/sal/yard","description":"Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26536","name":"Revise/implant finger joint","description":"Arthroplasty, interphalangeal joint; with prosthetic implant, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":600.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25490","name":"Prophylactic tx radius","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87269","name":"Giardia ag if","description":"Infectious agent antigen detection by immunofluorescent technique; giardia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24498","name":"Proph tx w/wo mthylmthcrylt","description":"Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45315","name":"Proctosigmoidoscopy removal","description":"Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25545","name":"Optx ulnar shft fx int fixj","description":"Open treatment of ulnar shaft fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50947","name":"Laparo new ureter/bladder","description":"Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1122.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95957","name":"Eeg digital analysis","description":"Digital analysis of electroencephalogram (eeg) (eg, for epileptic spike analysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4002","name":"Replace strap, any orthosis","description":"Replacement strap, any orthosis, includes all components, any length, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4265","name":"Paraffin","description":"Paraffin, per pound","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L8010","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80188","name":"Assay of primidone","description":"Primidone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21930","name":"Exc back les sc < 3 cm","description":"Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":410.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55041","name":"Removal of hydroceles","description":"Excision of hydrocele; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":414.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88302","name":"Tissue exam by pathologist","description":"Level ii - surgical pathology, gross and microscopic examination appendix, incidental fallopian tube, sterilization fingers/toes, amputation, traumatic foreskin, newborn hernia sac, any location hydrocele sac nerve skin, plastic repair sympathetic ganglion testis, castration vaginal mucosa, incident","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43191","name":"Esophagoscopy rigid trnso dx","description":"Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20937","name":"Sp bone agrft morsel add-on","description":"Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57530","name":"Removal of cervix","description":"Trachelectomy (cervicectomy), amputation of cervix (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24220","name":"Injection px for elbow arthg","description":"Injection procedure for elbow arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87149","name":"Dna/rna direct probe","description":"Culture, typing; identification by nucleic acid (dna or rna) probe, direct probe technique, per culture or isolate, each organism probed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34833","name":"Opn ilac art expos cndt crtj","description":"Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5628","name":"Test socket hemipelvectomy","description":"Addition to lower extremity, test socket, hemipelvectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01654","name":"Anes art sho&ax bypass grf","description":"Anesthesia for procedures on arteries of shoulder and axilla; bypass graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27045","name":"Exc hip/pelv tum deep 5 cm/>","description":"Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":629.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S0190","name":"Mifepristone, oral, 200 mg","description":"Mifepristone, oral, 200 mg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19282","name":"Perq device breast ea imag","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61536","name":"Removal of brain lesion","description":"Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85420","name":"Fibrinolytic plasminogen","description":"Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55860","name":"Surgical exposure prostate","description":"Exposure of prostate, any approach, for insertion of radioactive substance;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86200","name":"Ccp antibody","description":"Cyclic citrullinated peptide (ccp), antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83071","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7527","name":"Trach/laryn tube plug/stop","description":"Tracheostomy/laryngectomy tube plug/stop, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2430","name":"Knee jnt ratchet lock ea jnt","description":"Addition to knee joint, ratchet lock for active and progressive knee extension, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21401","name":"Closed tx orbit w/manipulj","description":"Closed treatment of fracture of orbit, except blowout; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75662","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77306","name":"Telethx isodose plan simple","description":"Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27894","name":"Decompression of leg","description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":715.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27269","name":"Optx thigh fx","description":"Open treatment of femoral fracture, proximal end, head, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1055.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29450","name":"Application clubfoot cast","description":"Application of clubfoot cast with molding or manipulation, long or short leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95070","name":"Inhlj brncl challenge tstg","description":"Inhalation bronchial challenge testing (not including necessary pulmonary function tests), with histamine, methacholine, or similar compounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31225","name":"Removal of upper jaw","description":"Maxillectomy; without orbital exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1367.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01924","name":"Anes ther ivntl rad artl nos","description":"Anesthesia for therapeutic interventional radiological procedures involving the arterial system; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67414","name":"Explr/decompress eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88364","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76812","name":"Ob us detailed addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77770","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49002","name":"Reopening of abdomen","description":"Reopening of recent laparotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41806","name":"Removal foreign body jawbone","description":"Removal of embedded foreign body from dentoalveolar structures; bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B9004","name":"Parenteral infus pump portab","description":"Parenteral nutrition infusion pump, portable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77336","name":"Radiation physics consult","description":"Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99288","name":"Direct advanced life support","description":"Physician or other qualified health care professional direction of emergency medical systems (ems) emergency care, advanced life support","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95131","name":"Immntx 2 sting insects","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5647","name":"Below knee suction socket","description":"Addition to lower extremity, below knee suction socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77075","name":"Radex osseous survey compl","description":"Radiologic examination, osseous survey; complete (axial and appendicular skeleton)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68328","name":"Revise/graft eyelid lining","description":"Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32540","name":"Removal of lung lesion","description":"Extrapleural enucleation of empyema (empyemectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93248","name":"Ext ecg>7d<15d rev&interpj","description":"External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77331","name":"Special radiation dosimetry","description":"Special dosimetry (eg, tld, microdosimetry) (specify), only when prescribed by the treating physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3730","name":"Forearm/arm cuffs ext/flex a","description":"Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87640","name":"Staph a dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); staphylococcus aureus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0634","name":"Lso flexion control custom","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, c","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L0210","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12013","name":"Rpr f/e/e/n/l/m 2.6-5.0 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87801","name":"Detect agnt mult dna ampli","description":"Infectious agent detection by nucleic acid (dna or rna), multiple organisms; amplified probe(s) technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22590","name":"Arthrd pst tq craniocervical","description":"Arthrodesis, posterior technique, craniocervical (occiput-c2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1418.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72291","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33214","name":"Upgrade of pacemaker system","description":"Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99188","name":"App topical fluoride varnish","description":"Application of topical fluoride varnish by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34834","name":"Opn brach art expos","description":"Open brachial artery exposure for delivery of endovascular prosthesis, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L1815","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94617","name":"Exercise tst brncspsm w/ecg","description":"Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic recording(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2101","name":"Single visn sphere 4.12-7.00","description":"Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86294","name":"Immunoassay tumor qual","description":"Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31291","name":"Nasal/sinus endoscopy surg","description":"Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid region","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7034","name":"Nasal application device","description":"Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31600","name":"Planned tracheostomy","description":"Tracheostomy, planned (separate procedure);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":239.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33788","name":"Revision of pulmonary artery","description":"Reimplantation of an anomalous pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27429","name":"Reconstruction knee","description":"Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1010","name":"Ctlso axilla sling","description":"Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4424","name":"Ost pch drain w bar & filter","description":"Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25392","name":"Shorten radius & ulna","description":"Osteoplasty, radius and ulna; shortening (excluding 64876)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":859.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66179","name":"Aqueous shunt eye w/o graft","description":"Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50290","name":"Excision perinephric cyst","description":"Excision of perinephric cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44376","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21510","name":"Inc deep opng b1 crtx thorax","description":"Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), thorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8000","name":"Mastectomy bra","description":"Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58543","name":"Lsh uterus above 250 g","description":"Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":539.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92579","name":"Visual audiometry (vra)","description":"Visual reinforcement audiometry (vra)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A7042","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85293","name":"Clot factor wght kininogen","description":"Clotting; high molecular weight kininogen assay (fitzgerald factor assay)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6411","name":"Non-sterile eye pad","description":"Eye pad, non-sterile, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47130","name":"Partial removal of liver","description":"Hepatectomy, resection of liver; total right lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2771.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95863","name":"Needle emg 3 extremities","description":"Needle electromyography; 3 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12056","name":"Intmd rpr face/mm 20.1-30.0","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":361.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0500","name":"Ippb all types","description":"Ippb machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87335","name":"E coli 0157 ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; escherichia coli 0157","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23397","name":"Muscle transfers","description":"Muscle transfer, any type, shoulder or upper arm; multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0481","name":"Intrpulmnry percuss vent sys","description":"Intrapulmonary percussive ventilation system and related accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28308","name":"Incision of metatarsal","description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95117","name":"Immunotherapy injections","description":"Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6208","name":"Contact layer > 48 sq in","description":"Contact layer, sterile, more than 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11420","name":"Exc h-f-nk-sp b9+marg 0.5/<","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26428","name":"Repair/graft finger tendon","description":"Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); with free graft (includes obtaining graft), each finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87560","name":"M.avium-intra dna dir prob","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria avium-intracellulare, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2200","name":"Lens spher bifoc plano 4.00d","description":"Sphere, bifocal, plano to plus or minus 4.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4612","name":"Battery cables","description":"Battery cables; replacement for patient-owned ventilator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15600","name":"Delay flap trunk","description":"Delay of flap or sectioning of flap (division and inset); at trunk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0941","name":"Gravity assisted traction de","description":"Gravity assisted traction device, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63287","name":"Bx/exc idrl imed lesn thrlmb","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2526.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34530","name":"Leg vein fusion","description":"Saphenopopliteal vein anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47382","name":"Percut ablate liver rf","description":"Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3381.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00865","name":"Anes xtrprt lwr abd prst8ect","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; radical prostatectomy (suprapubic, retropubic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45172","name":"Exc rect tum transanal full","description":"Excision of rectal tumor, transanal approach; including muscularis propria (ie, full thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19284","name":"Perq dev breast add strtctc","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76800","name":"Us exam spinal canal","description":"Ultrasound, spinal canal and contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99316","name":"Nf dschrg mgmt 30 min+","description":"Nursing facility discharge management; more than 30 minutes total time on the date of the encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92960","name":"Cardioversion electric ext","description":"Cardioversion, elective, electrical conversion of arrhythmia; external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84520","name":"Assay of urea nitrogen","description":"Urea nitrogen; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29886","name":"Arthrs knee surg drlg od les","description":"Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0462","name":"Rocking bed w/ or w/o side r","description":"Rocking bed with or without side rails","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B5100","name":"Parenteral solution hepatic","description":"Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, hepatic, hepatamine-premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54411","name":"Remov/replc penis pros comp","description":"Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54385","name":"Repair penis","description":"Plastic operation on penis for epispadias distal to external sphincter; with incontinence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84302","name":"Assay of sweat sodium","description":"Sodium; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8691","name":"Aoi snd proc repl excl actua","description":"Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1299.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97551","name":"Caregiver traing ea addl 15","description":"Caregiver training in strategies and techniques to facilitate the patients functional performance in the home or community (eg, activities of daily living [adls], instrumental adls [iadls], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64771","name":"Sever cranial nerve","description":"Transection or avulsion of other cranial nerve, extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":506.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28130","name":"Removal of ankle bone","description":"Talectomy (astragalectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":516.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90806","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28250","name":"Revision of foot fascia","description":"Division of plantar fascia and muscle (eg, steindler stripping) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":474.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67025","name":"Replace eye fluid","description":"Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0447T","name":"Rmvl impltbl glucose sensor","description":"Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26433","name":"Repair finger tendon","description":"Repair of extensor tendon, distal insertion, primary or secondary; without graft (eg, mallet finger)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64721","name":"Carpal tunnel surgery","description":"Neuroplasty and/or transposition; median nerve at carpal tunnel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30125","name":"Removal of nose lesion","description":"Excision dermoid cyst, nose; complex, under bone or cartilage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80428","name":"Growth hormone panel","description":"Growth hormone stimulation panel (eg, arginine infusion, l-dopa administration) this panel must include the following: human growth hormone (hgh) (83003 x 4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86340","name":"Intrinsic factor antibody","description":"Intrinsic factor antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73565","name":"X-ray exam of knees","description":"Radiologic examination, knee; both knees, standing, anteroposterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75805","name":"Lymph vessel x-ray trunk","description":"Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89160","name":"Exam feces for meat fibers","description":"Meat fibers, feces","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0801","name":"Pov group 1 hd 301-450 lbs","description":"Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39531","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":745.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32484","name":"Segmentectomy","description":"Removal of lung, other than pneumonectomy; single segment (segmentectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86665","name":"Epstein-barr capsid vca","description":"Antibody; epstein-barr (eb) virus, viral capsid (vca)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49326","name":"Lap w/omentopexy add-on","description":"Laparoscopy, surgical; with omentopexy (omental tacking procedure) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0829","name":"Pwc gp 2 xtra hd cap chair","description":"Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67825","name":"Revise eyelashes","description":"Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery, cryotherapy, laser surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49320","name":"Diag laparo separate proc","description":"Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99153","name":"Mod sed same phys/qhp ea","description":"Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33741","name":"Tas congenital car anomal","description":"Transcatheter atrial septostomy (tas) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, rashkind, sang-park, balloon, cutting balloon, blade)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50225","name":"Removal kidney open complex","description":"Nephrectomy, including partial ureterectomy, any open approach including rib resection; complicated because of previous surgery on same kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":983.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78472","name":"Gated heart planar single","description":"Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24305","name":"Tendon lngth upr a/e ea tdn","description":"Tendon lengthening, upper arm or elbow, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93924","name":"Lwr xtr vasc stdy bilat","description":"Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional doppler waveform or volume plethysmography recording and analysis at rest with ankle/brachial indices immediately after and at timed intervals following performance of a st","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76120","name":"Cine/video x-rays","description":"Cineradiography/videoradiography, except where specifically included","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83880","name":"Assay of natriuretic peptide","description":"Natriuretic peptide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7900","name":"Male vacuum erection system","description":"Male vacuum erection system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":256.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58280","name":"Hysterectomy/revise vagina","description":"Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25040","name":"Arthrt rdcrpl/midcarpl jt","description":"Arthrotomy, radiocarpal or midcarpal joint, with exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24635","name":"Optx monteggia fx dislc elbw","description":"Open treatment of monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46735","name":"Construction of absent anus","description":"Repair of high imperforate anus without fistula; combined transabdominal and sacroperineal approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29915","name":"Hip arthro acetabuloplasty","description":"Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":864.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69209","name":"Remove impacted ear wax uni","description":"Removal impacted cerumen using irrigation/lavage, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83631","name":"Lactoferrin fecal (quant)","description":"Lactoferrin, fecal; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44640","name":"Repair bowel-skin fistula","description":"Closure of intestinal cutaneous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82436","name":"Assay of urine chloride","description":"Chloride; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27612","name":"Exploration of ankle joint","description":"Arthrotomy, posterior capsular release, ankle, with or without achilles tendon lengthening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70498","name":"Ct angiography neck","description":"Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27138","name":"Revise hip joint replacement","description":"Revision of total hip arthroplasty; femoral component only, with or without allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15050","name":"Pinch graft up to 2 cm diam","description":"Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45000","name":"Drainage of pelvic abscess","description":"Transrectal drainage of pelvic abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31530","name":"Laryngoscopy w/fb removal","description":"Laryngoscopy, direct, operative, with foreign body removal;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82103","name":"Alpha-1-antitrypsin total","description":"Alpha-1-antitrypsin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3254","name":"Orth foot non-stndard size/w","description":"Non-standard size or width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00936","name":"Anes rad amp pns ingun&ilac","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal and iliac lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15825","name":"Rhytdct nck pltysml tghtg","description":"Rhytidectomy; neck with platysmal tightening (platysmal flap, p-flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99484","name":"Care mgmt svc bhvl hlth cond","description":"Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of appli","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55880","name":"Abltj mal prst8 tiss hifu","description":"Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (hifu), including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6100","name":"Elb mold sock flex hinge pad","description":"Below elbow, molded socket, flexible elbow hinge, triceps pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00567","name":"Anes direct cabg w/pump","description":"Anesthesia for direct coronary artery bypass grafting; with pump oxygenator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23075","name":"Exc shoulder les sc < 3 cm","description":"Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32480","name":"Partial removal of lung","description":"Removal of lung, other than pneumonectomy; single lobe (lobectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64746","name":"Incise diaphragm nerve","description":"Transection or avulsion of; phrenic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":371.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6256","name":"Absorpt drg > 48 sq in w/bdr","description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54115","name":"Treatment of penis lesion","description":"Removal foreign body from deep penile tissue (eg, plastic implant)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70546","name":"Mr angiograph head w/o&w/dye","description":"Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00560","name":"Anes px heart w/o pump oxtj","description":"Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28280","name":"Fusion of toes","description":"Syndactylization, toes (eg, webbing or kelikian type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":416.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83033","name":"Hemoglobin ftl f assay qual","description":"Hemoglobin; f (fetal), qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0499","name":"Belt/vest elec/combo vad rep","description":"Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74440","name":"X-ray male genital tract","description":"Vasography, vesiculography, or epididymography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61020","name":"Remove brain cavity fluid","description":"Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75880","name":"Vein x-ray eye socket","description":"Venography, orbital, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47610","name":"Removal of gallbladder","description":"Cholecystectomy with exploration of common duct;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1050.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90470","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28289","name":"Corrj halux rigdus w/o implt","description":"Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23100","name":"Arthrotomy glenhumrl jt w/bx","description":"Arthrotomy, glenohumeral joint, including biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00162","name":"Anes px nose&sinus rad surg","description":"Anesthesia for procedures on nose and accessory sinuses; radical surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63066","name":"Decompress spine cord add-on","description":"Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":191.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93797","name":"Phys/qhp op car rhab wo ecg","description":"Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ecg monitoring (per session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46200","name":"Removal of anal fissure","description":"Fissurectomy, including sphincterotomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":363.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86825","name":"Hla x-math non-cytotoxic","description":"Human leukocyte antigen (hla) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87902","name":"Nfct agt gntyp alys hep c","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); hepatitis c virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52351","name":"Cystouretero & or pyeloscope","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91030","name":"Acid perfusion of esophagus","description":"Esophagus, acid perfusion (bernstein) test for esophagitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25350","name":"Revision of radius","description":"Osteotomy, radius; distal third","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":565.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62268","name":"Drain spinal cord cyst","description":"Percutaneous aspiration, spinal cord cyst or syrinx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":207.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00944","name":"Anes vag px vag hysterectomy","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); vaginal hysterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64870","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":828.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41112","name":"Excision of tongue lesion","description":"Excision of lesion of tongue with closure; anterior two-thirds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82172","name":"Assay of apolipoprotein","description":"Apolipoprotein, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93790","name":"Ambl bp mntr w/sw i&r","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; review with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51845","name":"Repair bladder neck","description":"Abdomino-vaginal vesical neck suspension, with or without endoscopic control (eg, stamey, raz, modified pereyra)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":470.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78585","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":299.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86641","name":"Cryptococcus antibody","description":"Antibody; cryptococcus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2292","name":"Planar seat for ped size wc","description":"Seat, planar, for pediatric size wheelchair including fixed attaching hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68816","name":"Probe nl duct w/balloon","description":"Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5632","name":"Symes type ptb brim design s","description":"Addition to lower extremity, symes type, ptb brim design socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83900","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77790","name":"Radiation handling","description":"Supervision, handling, loading of radiation source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82728","name":"Assay of ferritin","description":"Ferritin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5705","name":"Custom shape cover ak","description":"Custom shaped protective cover, above knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0398T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1145.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43117","name":"Partial removal of esophagus","description":"Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty (ivor lewis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42830","name":"Removal of adenoids","description":"Adenoidectomy, primary; younger than age 12","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4394","name":"Replace foot drop spint","description":"Replace soft interface material, foot drop splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0446T","name":"Insj impltbl glucose sensor","description":"Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1522.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62280","name":"Treat spinal cord lesion","description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":292.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25425","name":"Repair/graft radius or ulna","description":"Repair of defect with autograft; radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25066","name":"Biopsy forearm soft tissues","description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41120","name":"Partial removal of tongue","description":"Glossectomy; less than one-half tongue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":824.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68440","name":"Snip inc lacrimal punctum","description":"Snip incision of lacrimal punctum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00218","name":"Anes icr px in sitting pos","description":"Anesthesia for intracranial procedures; procedures in sitting position","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63030","name":"Lamot dcmprn nrv rt 1 lmbr","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":859.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0002","name":"Stnd hemi (low seat) whlchr","description":"Standard hemi (low seat) wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54416","name":"Remv/repl penis contain pros","description":"Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":575.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29710","name":"Rmvl/bivlv sho/hip spica","description":"Removal or bivalving; shoulder or hip spica, minerva, or risser jacket, etc.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21440","name":"Cltx mndblr/max alv ridge fx","description":"Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":506.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0321","name":"Audio-only hhs","description":"Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35905","name":"Excision graft thorax","description":"Excision of infected graft; thorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1553.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82947","name":"Assay glucose blood quant","description":"Glucose; quantitative, blood (except reagent strip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25035","name":"Inc dp bone crtx f/arm&/wrst","description":"Incision, deep, bone cortex, forearm and/or wrist (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":489.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19000","name":"Puncture aspir cyst breast","description":"Puncture aspiration of cyst of breast;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99283","name":"Emergency dept visit low mdm","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0968","name":"Wheelchair commode seat","description":"Commode seat, wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33883","name":"Delayed plmt prox xtn prosth","description":"Delayed placement of proximal extension prosthesis(es) not involving coverage of the left subclavian artery origin, after endovascular repair of the thoracic aorta, including pre-procedure sizing and device selection, nonselective catheterization(s), all associated radiological supervision and inter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":971.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6386","name":"Postop ea cast chg & realign","description":"Immediate post surgical or early fitting, each additional cast change and realignment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89329","name":"Sperm evaluation test","description":"Sperm evaluation; hamster penetration test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69020","name":"Drg xtrnl aud canal abscess","description":"Drainage external auditory canal, abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83518","name":"Immunoassay dipstick","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, single step method (eg, reagent strip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97012","name":"Mechanical traction therapy","description":"Application of a modality to 1 or more areas; traction, mechanical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89325","name":"Sperm antibody test","description":"Sperm antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4224","name":"Parenteral administration ki","description":"Parenteral nutrition administration kit, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96377","name":"Applicaton on-body injector","description":"Application of on-body injector (includes cannula insertion) for timed subcutaneous injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21385","name":"Opn tx orbit fx transantral","description":"Open treatment of orbital floor blowout fracture; transantral approach (caldwell-luc type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90945","name":"Dialysis one evaluation","description":"Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33824","name":"Repair pda div 18 yrs&older","description":"Repair of patent ductus arteriosus; by division, 18 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98929","name":"Osteopath manj 9-10 regions","description":"Osteopathic manipulative treatment (omt); 9-10 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96920","name":"Excimer lsr psriasis<250sqcm","description":"Excimer laser treatment for psoriasis; total area less than 250 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58820","name":"Drain ovary abscess open","description":"Drainage of ovarian abscess; vaginal approach, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44139","name":"Mobilization of colon","description":"Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64412","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0830","name":"Halo cerv into milwaukee typ","description":"Halo procedure, cervical halo incorporated into milwaukee type orthosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1460.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27652","name":"Repair/graft achilles tendon","description":"Repair, primary, open or percutaneous, ruptured achilles tendon; with graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01933","name":"Anes ther ivntl rad px icr","description":"Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intracranial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32669","name":"Thoracoscopy remove segment","description":"Thoracoscopy, surgical; with removal of a single lung segment (segmentectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8417","name":"Pros sheath/sock w gel cushn","description":"Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33976","name":"Implant ventricular device","description":"Insertion of ventricular assist device; extracorporeal, biventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33233","name":"Removal of pm generator","description":"Removal of permanent pacemaker pulse generator only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67413","name":"Explore/treat eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":552.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46612","name":"Anoscopy remove lesions","description":"Anoscopy; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95010","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32120","name":"Re-exploration of chest","description":"Thoracotomy; for postoperative complications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":694.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2004","name":"Post-d/c h vst new pt 60 m","description":"Comprehensive (60 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient faci","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6205","name":"Elbow molded w/ expand inter","description":"Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0861","name":"Pwc gp3 std mult pow opt s/b","description":"Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22315","name":"Closed tx vert fx w/manj","description":"Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0248","name":"Demonstrate use home inr mon","description":"Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57720","name":"Revision of cervix","description":"Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95929","name":"C motor evoked lwr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42950","name":"Reconstruction of throat","description":"Pharyngoplasty (plastic or reconstructive operation on pharynx)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":620.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77326","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36823","name":"Insertion of cannula(s)","description":"Insertion of arterial and venous cannula(s) for isolated extracorporeal circulation including regional chemotherapy perfusion to an extremity, with or without hyperthermia, with removal of cannula(s) and repair of arteriotomy and venotomy sites","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1225.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46924","name":"Destruction anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1070","name":"Wheelchair detachable foot r","description":"Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22326","name":"Treat neck spine fracture","description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1338.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50205","name":"Renal bx surg exposure kdn","description":"Renal biopsy; by surgical exposure of kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":653.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0576T","name":"Interrog dev eval icds ss ip","description":"Interrogation device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode, with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95004","name":"Perq tests w/alrgnc xtrcs","description":"Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43832","name":"Gstrst open w/constj tube","description":"Gastrostomy, open; with construction of gastric tube (eg, janeway procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":867.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2394","name":"Drive wheel excludes tire","description":"Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0161","name":"Sitz bath/equipment w/faucet","description":"Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0052","name":"Swingaway detach ftrest repl","description":"Swingaway, detachable footrests, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0607","name":"Repl batt for aed","description":"Replacement battery for automated external defibrillator, garment type only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30600","name":"Repair mouth/nose fistula","description":"Repair fistula; oronasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37605","name":"Ligation int/com carotid art","description":"Ligation; internal or common carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25609","name":"Optx dst rd xart fx/ep sep3+","description":"Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":880.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0181","name":"Press pad alternating w/ pum","description":"Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35241","name":"Rpr blvsl vn grf ntrthrc w/b","description":"Repair blood vessel with vein graft; intrathoracic, with bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1243.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0890","name":"Pwc gp5 ped sing pow opt s/b","description":"Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5701","name":"Replace socket above knee","description":"Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61645","name":"Perq art m-thrombect &/nfs","description":"Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":724.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4210","name":"Orth dev repair/repl minor p","description":"Repair of orthotic device, repair or replace minor parts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47120","name":"Partial removal of liver","description":"Hepatectomy, resection of liver; partial lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1947.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33508","name":"Endoscopic vein harvest","description":"Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55060","name":"Repair of hydrocele","description":"Repair of tunica vaginalis hydrocele (bottle type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4211","name":"Supp for self-adm injections","description":"Supplies for self-administered injections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92546","name":"Sinusoidal rotational test","description":"Sinusoidal vertical axis rotational testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4231","name":"Infusion insulin pump needle","description":"Infusion set for external insulin pump, needle type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85097","name":"Bone marrow interpretation","description":"Bone marrow, smear interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64636","name":"Destroy l/s facet jnt addl","description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); lumbar or sacral, each additional facet joint (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20604","name":"Drain/inj joint/bursa w/us","description":"Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29860","name":"Hip arthroscopy dx","description":"Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":563.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78270","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0880","name":"Trac stand free stand extrem","description":"Traction stand, free standing, extremity traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58561","name":"Hysteroscopy remove myoma","description":"Hysteroscopy, surgical; with removal of leiomyomata","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84445","name":"Assay of tsi globulin","description":"Thyroid stimulating immune globulins (tsi)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0403T","name":"Diabetes prev standard curr","description":"Preventive behavior change, intensive program of prevention of diabetes using a standardized diabetes prevention program curriculum, provided to individuals in a group setting, minimum 60 minutes, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2070","name":"Hkafo torsion unilat rot str","description":"Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25444","name":"Arthrp w/prostc lunate","description":"Arthroplasty with prosthetic replacement; lunate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22810","name":"Arthrd ant dfrm 4-7 vrt sgm","description":"Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1812.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86235","name":"Nuclear antigen antibody","description":"Extractable nuclear antigen, antibody to, any method (eg, nrnp, ss-a, ss-b, sm, rnp, sc170, j01), each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53450","name":"Revision of urethra","description":"Urethromeatoplasty, with mucosal advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0624","name":"Sio panel custom","description":"Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63285","name":"Bx/exc idrl imed lesn cervl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2405.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31255","name":"Nsl/sins ndsc w/tot ethmdct","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48120","name":"Removal of pancreas lesion","description":"Excision of lesion of pancreas (eg, cyst, adenoma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21032","name":"Remove exostosis maxilla","description":"Excision of maxillary torus palatinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6025","name":"Silicone gel sheet, each","description":"Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4270","name":"Disposable endoscope sheath","description":"Disposable endoscope sheath, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35881","name":"Revise graft w/vein","description":"Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50020","name":"Drg perirnl/renal absc open","description":"Drainage of perirenal or renal abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4180","name":"Parenteral sol carb > 50%","description":"Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26352","name":"Repair/graft hand tendon","description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no mans land); secondary with free graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":672.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70380","name":"X-ray exam of salivary gland","description":"Radiologic examination, salivary gland for calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63685","name":"Ins/rplc spi npg/rcvr pocket","description":"Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9983","name":"Remote e/m est. pt 10mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21206","name":"Reconstruct upper jaw bone","description":"Osteotomy, maxilla, segmental (eg, wassmund or schuchard)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38215","name":"Harvest stem cell concentrte","description":"Transplant preparation of hematopoietic progenitor cells; cell concentration in plasma, mononuclear, or buffy coat layer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33915","name":"Remove lung artery emboli","description":"Pulmonary artery embolectomy; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41510","name":"Tongue to lip surgery","description":"Suture of tongue to lip for micrognathia (douglas type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87158","name":"Culture typing added method","description":"Culture, typing; other methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76977","name":"Us bone density measure","description":"Ultrasound bone density measurement and interpretation, peripheral site(s), any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99478","name":"Sbsq ic vlbw inf<1,500 gm","description":"Subsequent intensive care, per day, for the evaluation and management of the recovering very low birth weight infant (present body weight less than 1,500 grams)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26545","name":"Reconstruct finger joint","description":"Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33621","name":"Transthor cath for stent","description":"Transthoracic insertion of catheter for stent placement with catheter removal and closure (eg, hybrid approach stage 1)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":806.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44640","name":"Repair bowel-skin fistula","description":"Closure of intestinal cutaneous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1154.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33916","name":"Surgery of great vessel","description":"Pulmonary endarterectomy, with or without embolectomy, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61686","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; infratentorial, complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4382.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41874","name":"Alveoloplasty each quadrant","description":"Alveoloplasty, each quadrant (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61541","name":"Incision of brain tissue","description":"Craniotomy with elevation of bone flap; for transection of corpus callosum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1970.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45337","name":"Sigmoidoscopy & decompress","description":"Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99467","name":"Ped crit care transport addl","description":"Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; each additional 30 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28120","name":"Part removal of ankle/heel","description":"Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0179","name":"Md recertification hha pt","description":"Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59871","name":"Remove cerclage suture","description":"Removal of cerclage suture under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0827","name":"Pwc gp vhd cap chair","description":"Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86039","name":"Antinuclear antibodies (ana)","description":"Antinuclear antibodies (ana); titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92616","name":"Fees w/laryngeal sense test","description":"Flexible endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78414","name":"Non-imaging heart function","description":"Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without pharmacologic intervention or exercise, single or multiple determinations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51710","name":"Change of bladder tube","description":"Change of cystostomy tube; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42835","name":"Removal of adenoids","description":"Adenoidectomy, secondary; younger than age 12","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43500","name":"Surgical opening of stomach","description":"Gastrotomy; with exploration or foreign body removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":650.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26517","name":"Fusion of knuckle joints","description":"Capsulodesis, metacarpophalangeal joint; 2 digits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":702.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22614","name":"Arthrd pst tq 1ntrspc ea add","description":"Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88373","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28020","name":"Exploration of foot joint","description":"Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or tarsometatarsal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52355","name":"Cystouretero w/excise tumor","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of ureteral or renal pelvic tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17282","name":"Dstr mal ls f/e/e/n/l/m1.1-2","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37210","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3860.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0278T","name":"Tempr","description":"Transcutaneous electrical modulation pain reprocessing (eg, scrambler therapy), each treatment session (includes placement of electrodes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92533","name":"Caloric vestibular test","description":"Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73070","name":"X-ray exam of elbow","description":"Radiologic examination, elbow; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4561","name":"Pessary reusable rub anytype","description":"Pessary, reusable, rubber, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69604","name":"Revj mstdc rsltg tympanplsty","description":"Revision mastoidectomy; resulting in tympanoplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62146","name":"Crnop w/autograft<5 cm diam","description":"Cranioplasty with autograft (includes obtaining bone grafts); up to 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":981.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29740","name":"Wedging of cast","description":"Wedging of cast (except clubfoot casts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83009","name":"H pylori (c-13) blood","description":"Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope (eg, c-13)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1800","name":"Adjust elbow ext & flex dev","description":"Dynamic adjustable elbow extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1831","name":"Knee orth pos locking joint","description":"Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26490","name":"Revise thumb tendon","description":"Opponensplasty; superficialis tendon transfer type, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":676.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00563","name":"Anes px heart w/pmp crc arst","description":"Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C2617","name":"Stent, non-cor, tem w/o del","description":"Stent, non-coronary, temporary, without delivery system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64590","name":"Ins/rpl prph sac/gstr npg/r","description":"Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29851","name":"Knee arthroscopy/surgery","description":"Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":786.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92285","name":"External ocular photography","description":"External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, slit lamp photography, goniophotography, stereo-photography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13150","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27041","name":"Biopsy of soft tissues","description":"Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2303","name":"Lens sphcy trifocal 4.0/.12-","description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82965","name":"Assay of gdh enzyme","description":"Glutamate dehydrogenase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26498","name":"Finger tendon transfer","description":"Transfer of tendon to restore intrinsic function; all 4 fingers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":970.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37235","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2048.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73552","name":"X-ray exam of femur 2/>","description":"Radiologic examination, femur; minimum 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77052","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92626","name":"Eval aud funcj 1st hour","description":"Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50205","name":"Renal bx surg exposure kdn","description":"Renal biopsy; by surgical exposure of kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26125","name":"Release palm contracture","description":"Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft); each additional digit (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":229.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0003","name":"Lightweight wheelchair","description":"Lightweight wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87533","name":"Hhv-6 dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); herpes virus-6, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3905","name":"Who w/nontorsion jnt(s) cf","description":"Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":259.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0485T","name":"Oct mid ear i&r unilateral","description":"Optical coherence tomography (oct) of middle ear, with interpretation and report; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6130","name":"Elbow stump activated lock h","description":"Below elbow, molded double wall split socket, stump activated locking hinge, half cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28250","name":"Revision of foot fascia","description":"Division of plantar fascia and muscle (eg, steindler stripping) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50045","name":"Nephrotomy w/exploration","description":"Nephrotomy, with exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":753.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33322","name":"Repair major blood vessel(s)","description":"Suture repair of aorta or great vessels; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1203.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41113","name":"Excision of tongue lesion","description":"Excision of lesion of tongue with closure; posterior one-third","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15946","name":"Exc isch pr ulc prep mus flp","description":"Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93990","name":"Doppler flow testing","description":"Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64479","name":"Njx aa&/strd tfrm epi c/t 1","description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or ct), cervical or thoracic, single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64480","name":"Njx aa&/strd tfrm epi c/t ea","description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or ct), cervical or thoracic, each additional level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6242","name":"Hydrogel drg <=16 in w/o bdr","description":"Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92557","name":"Comprehensive hearing test","description":"Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84311","name":"Spectrophotometry","description":"Spectrophotometry, analyte not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25120","name":"Removal of forearm lesion","description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63688","name":"Rev/rmv imp sp npg/r dtch cn","description":"Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6706","name":"Term dev mech hook vol open","description":"Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43045","name":"Esophagotomy thrc rmvl fb","description":"Esophagotomy, thoracic approach, with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1074.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64488","name":"Tap block bi injection","description":"Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33802","name":"Division aberrant vessel","description":"Division of aberrant vessel (vascular ring);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":938.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46760","name":"Repair of anal sphincter","description":"Sphincteroplasty, anal, for incontinence, adult; muscle transplant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88329","name":"Path consltj drg surg","description":"Pathology consultation during surgery;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0251","name":"Hosp bed fixd ht w/o mattres","description":"Hospital bed, fixed height, with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44407","name":"Colonoscopy w/ndl aspir/bx","description":"Colonoscopy through stoma; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92283","name":"Extnd color vision xm","description":"Color vision examination, extended, eg, anomaloscope or equivalent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75630","name":"X-ray aorta leg arteries","description":"Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85370","name":"Fibrinogen test","description":"Fibrin(ogen) degradation (split) products (fdp) (fsp); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63275","name":"Bx/exc xdrl spine lesn crvl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36904","name":"Thrmbc/nfs dialysis circuit","description":"Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thromboly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":958.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00872","name":"Anes lithotrp esw water bath","description":"Anesthesia for lithotripsy, extracorporeal shock wave; with water bath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27130","name":"Total hip arthroplasty","description":"Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1150.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15838","name":"Exc excsv submental fat pad","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84081","name":"Assay phosphatidylglycerol","description":"Phosphatidylglycerol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83874","name":"Assay of myoglobin","description":"Myoglobin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44205","name":"Lap colectomy part w/ileum","description":"Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1093.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58260","name":"Vaginal hysterectomy","description":"Vaginal hysterectomy, for uterus 250 g or less;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":534.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83903","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9187","name":"Bpci home visit","description":"Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/managemen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7045","name":"Repl exhalation port for pap","description":"Exhalation port with or without swivel used with accessories for positive airway devices, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37241","name":"Vasc embolize/occlude venous","description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37700","name":"Ligation&div long saph vein","description":"Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54105","name":"Biopsy of penis","description":"Biopsy of penis; deep structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27616","name":"Resect leg/ankle tum 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1087.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73222","name":"Mri joint upr extrem w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5072","name":"Urinary pouch w/o barrier","description":"Ostomy pouch, urinary; without barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97018","name":"Paraffin bath therapy","description":"Application of a modality to 1 or more areas; paraffin bath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95028","name":"Iq tsts allergy delayed rxn","description":"Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33289","name":"Tcat impl wrls p-art prs snr","description":"Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiog","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54535","name":"Extensive testis surgery","description":"Orchiectomy, radical, for tumor; with abdominal exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":602.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25492","name":"Prophylactic tx radius&ulna","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":765.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33411","name":"Replacement of aortic valve","description":"Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35901","name":"Excision graft neck","description":"Excision of infected graft; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8000","name":"Mastectomy bra","description":"Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5590","name":"Prep ak ischial laminated","description":"Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1323.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62190","name":"Establish brain cavity shunt","description":"Creation of shunt; subarachnoid/subdural-atrial, -jugular, -auricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0246","name":"Transfer tub rail attachment","description":"Transfer tub rail attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15738","name":"Muscle-skin graft leg","description":"Muscle, myocutaneous, or fasciocutaneous flap; lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87807","name":"Rsv assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0898","name":"Power wheelchair noc","description":"Power wheelchair, not otherwise classified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01390","name":"Anes cls px upr tib fib&/pat","description":"Anesthesia for all closed procedures on upper ends of tibia, fibula, and/or patella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73721","name":"Mri jnt of lwr extre w/o dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99375","name":"Home health care supervision","description":"Supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (eg, alzheimers facility) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52400","name":"Cysto cgen post urtl valves","description":"Cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50545","name":"Laparo radical nephrectomy","description":"Laparoscopy, surgical; radical nephrectomy (includes removal of gerotas fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1084.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44365","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60212","name":"Partial thyroid excision","description":"Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20670","name":"Removal implant superficial","description":"Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49525","name":"Repair ing hernia sliding","description":"Repair inguinal hernia, sliding, any age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61250","name":"Burr hole/treph sttl expl","description":"Burr hole(s) or trephine, supratentorial, exploratory, not followed by other surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15274","name":"Skn sub grft t/a/l child add","description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71047","name":"X-ray exam chest 3 views","description":"Radiologic examination, chest; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64857","name":"Repair arm/leg nerve","description":"Suture of major peripheral nerve, arm or leg, except sciatic; without transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":884.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93641","name":"Ep evl 1/2chmb pac cvdfb tst","description":"Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35458","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":425.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15570","name":"Skin pedicle flap trunk","description":"Formation of direct or tubed pedicle, with or without transfer; trunk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45910","name":"Dilation of rectal narrowing","description":"Dilation of rectal stricture (separate procedure) under anesthesia other than local","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4178","name":"Parenteral sol amino acid >","description":"Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19294","name":"Prepj tum cav iort prtl mast","description":"Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (iort) concurrent with partial mastectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99401","name":"Prev med cnsl indiv apprx 15","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21407","name":"Opn tx orbit fx w/implant","description":"Open treatment of fracture of orbit, except blowout; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33208","name":"Insrt heart pm atrial & vent","description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0293","name":"Hosp bed var ht no sr no mat","description":"Hospital bed, variable height, hi-lo, without side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40801","name":"Drainage of mouth lesion","description":"Drainage of abscess, cyst, hematoma, vestibule of mouth; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62201","name":"Brain cavity shunt w/scope","description":"Ventriculocisternostomy, third ventricle; stereotactic, neuroendoscopic method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1093.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2214","name":"Init/sub psych care m 1st 30","description":"Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15131","name":"Drm agrft t/a/l ea addl","description":"Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95869","name":"Ndl emg thrc paraspinal musc","description":"Needle electromyography; thoracic paraspinal muscles (excluding t1 or t12)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92537","name":"Caloric vstblr test w/rec","description":"Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32501","name":"Repair bronchus add-on","description":"Resection and repair of portion of bronchus (bronchoplasty) when performed at time of lobectomy or segmentectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82441","name":"Test for chlorohydrocarbons","description":"Chlorinated hydrocarbons, screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5976","name":"Energy storing foot","description":"All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5100","name":"Molded socket shin sach foot","description":"Below knee, molded socket, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92541","name":"Spontaneous nystagmus test","description":"Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26477","name":"Tendon shortening","description":"Shortening of tendon, extensor, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43180","name":"Esophagoscopy rigid trnso","description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, zenkers diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72141","name":"Mri neck spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84206","name":"Assay of proinsulin","description":"Proinsulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15760","name":"Composite skin graft","description":"Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43633","name":"Removal of stomach partial","description":"Gastrectomy, partial, distal; with roux-en-y reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1611.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5728","name":"Knee-shin fluid swg & stance","description":"Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1313.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01320","name":"Anes all px nrv msc kne&/pop","description":"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15852","name":"Dressing change not for burn","description":"Dressing change (for other than burns) under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62194","name":"Replace/irrigate catheter","description":"Replacement or irrigation, subarachnoid/subdural catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84166","name":"Protein e-phoresis/urine/csf","description":"Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, csf)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77073","name":"Bone length studies","description":"Bone length studies (orthoroentgenogram, scanogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69502","name":"Mastoidectomy","description":"Mastoidectomy; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":770.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29825","name":"Sho arthrs srg lss&rescj ads","description":"Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":493.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7508","name":"Housing & integrated adhesiv","description":"Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37192","name":"Redo endovas vena cava filtr","description":"Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1110.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99337","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78710","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43251","name":"Egd remove lesion snare","description":"Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36465","name":"Njx noncmpnd sclrsnt 1 vein","description":"Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1226.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00840","name":"Anes iper px lower abd nos","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27613","name":"Biopsy lower leg soft tissue","description":"Biopsy, soft tissue of leg or ankle area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27831","name":"Treat lower leg dislocation","description":"Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88720","name":"Bilirubin total transcut","description":"Bilirubin, total, transcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85520","name":"Heparin assay","description":"Heparin assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP03","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87285","name":"Treponema pallidum ag if","description":"Infectious agent antigen detection by immunofluorescent technique; treponema pallidum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41806","name":"Removal foreign body jawbone","description":"Removal of embedded foreign body from dentoalveolar structures; bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":307.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25028","name":"I&d f/arm&/wrst dp absc/hmtm","description":"Incision and drainage, forearm and/or wrist; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24670","name":"Cltx ulnar fx prox w/o mnpj","description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4671","name":"Disposable cycler set","description":"Disposable cycler set used with cycler dialysis machine, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99483","name":"Assmt & care pln pt cog imp","description":"Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: cognition-focused evaluation including a pertinent history and examination, m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2291","name":"Planar back for ped size wc","description":"Back, planar, for pediatric size wheelchair including fixed attaching hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1020","name":"Kyphosis pad","description":"Addition to ctlso or scoliosis orthosis, kyphosis pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26517","name":"Fusion of knuckle joints","description":"Capsulodesis, metacarpophalangeal joint; 2 digits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87635","name":"Sars-cov-2 covid-19 amp prb","description":"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27170","name":"Repair/graft femur head/neck","description":"Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes obtaining bone graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":996.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21199","name":"Reconstr lwr jaw w/advance","description":"Osteotomy, mandible, segmental; with genioglossus advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2755","name":"Uv lens/es","description":"U-v lens, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77470","name":"Special radiation treatment","description":"Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral or endocavitary irradiation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84580","name":"Assay of urine urobilinogen","description":"Urobilinogen, urine; quantitative, timed specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86353","name":"Lymphocyte transformation","description":"Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1768","name":"Graft, vascular","description":"Graft, vascular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":707.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88325","name":"Consltj compre rvw rec reprt","description":"Consultation, comprehensive, with review of records and specimens, with report on referred material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89060","name":"Exam synovial fluid crystals","description":"Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74329","name":"X-ray for pancreas endoscopy","description":"Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2313","name":"Lens sphc trifo 7.25-12/4.25","description":"Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51535","name":"Repair of ureter lesion","description":"Cystotomy for excision, incision, or repair of ureterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98980","name":"Rtm tx mgmt 1st 20 min","description":"Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; first 20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26951","name":"Amputation of finger/thumb","description":"Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77072","name":"Bone age studies","description":"Bone age studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45120","name":"Removal of rectum","description":"Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with pull-through procedure and anastomosis (eg, swenson, duhamel, or soave type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33237","name":"Remove electrode/thoracotomy","description":"Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20520","name":"Rmvl fb musc/tdn simple","description":"Removal of foreign body in muscle or tendon sheath; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26370","name":"Repair finger/hand tendon","description":"Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54235","name":"Njx corpora cavernosa rx agt","description":"Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33692","name":"Comp rpr tof wo pulm atresia","description":"Complete repair tetralogy of fallot without pulmonary atresia;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80176","name":"Assay of lidocaine","description":"Lidocaine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0497","name":"Bat clps elec/comb vad, rep","description":"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49424","name":"Assess cyst contrast inject","description":"Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99336","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32663","name":"Thoracoscopy w/lobectomy","description":"Thoracoscopy, surgical; with lobectomy (single lobe)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53210","name":"Removal of urethra","description":"Urethrectomy, total, including cystostomy; female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":635.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29847","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; internal fixation for fracture or instability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47765","name":"Fuse liver ducts & bowel","description":"Anastomosis, of intrahepatic ducts and gastrointestinal tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50360","name":"Rnl altrnsplj w/o rcp nfrct","description":"Renal allotransplantation, implantation of graft; without recipient nephrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33983","name":"Replace vad intra w/bp","description":"Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2019.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61885","name":"Insrt/redo neurostim 1 array","description":"Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93609","name":"Intra-vntr mapg tchycar site","description":"Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98975","name":"Rtm 1st set-up&pt educaj eqp","description":"Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); initial set-up and patient education on use of equipment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68770","name":"Close tear system fistula","description":"Closure of lacrimal fistula (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63190","name":"Incise spine nrv >2 segmnts","description":"Laminectomy with rhizotomy; more than 2 segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1057.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69145","name":"Remove ear canal lesion(s)","description":"Excision soft tissue lesion, external auditory canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9982","name":"Remote e/m new pt 60mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3650","name":"So 8 abd restraint pre ots","description":"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31588","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":845.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7040","name":"Prehensile actuator","description":"Prehensile actuator, switch controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1514.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49540","name":"Repair lumbar hernia","description":"Repair lumbar hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22010","name":"I&d p-spine c/t/cerv-thor","description":"Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":840.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51860","name":"Repair of bladder wound","description":"Cystorrhaphy, suture of bladder wound, injury or rupture; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0672","name":"Removable soft interface le","description":"Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93563","name":"Njx cgen car cth slctv c ang","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77263","name":"Ther radiology tx plng cplx","description":"Therapeutic radiology treatment planning; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19355","name":"Correct inverted nipple(s)","description":"Correction of inverted nipples","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29750","name":"Wedging of clubfoot cast","description":"Wedging of clubfoot cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61050","name":"Remove brain canal fluid","description":"Cisternal or lateral cervical (c1-c2) puncture; without injection (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50250","name":"Opn abltj 1/> rnl mas crysrg","description":"Ablation, open, 1 or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound guidance and monitoring, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":984.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0353T","name":"Intraop oct breast cavity","description":"Optical coherence tomography of breast, surgical cavity; real-time intraoperative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14302","name":"Tis trnfr addl 30 sq cm","description":"Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8999","name":"Resuscitation bag","description":"Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21195","name":"Reconst lwr jaw w/o fixation","description":"Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69805","name":"Explore inner ear","description":"Endolymphatic sac operation; without shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":838.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28130","name":"Removal of ankle bone","description":"Talectomy (astragalectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5081","name":"Stoma plug or seal, any type","description":"Stoma plug or seal, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93654","name":"Compre ep eval tx vt","description":"Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensiona","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1196.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01520","name":"Anes px veins lower leg nos","description":"Anesthesia for procedures on veins of lower leg; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47143","name":"Prep donor liver whole","description":"Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without triseg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27810","name":"Treatment of ankle fracture","description":"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36860","name":"External cannula declotting","description":"External cannula declotting (separate procedure); without balloon catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41827","name":"Excision of gum lesion","description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":343.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81275","name":"Kras gene variants exon 2","description":"Kras (kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and 13)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15771","name":"Grfg autol fat lipo 50 cc/<","description":"Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":367.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29855","name":"Tibial arthroscopy/surgery","description":"Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21048","name":"Remove maxilla cyst complex","description":"Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21267","name":"Revise eye sockets","description":"Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1356.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2214","name":"Lens sphcyl bifocal over 12.","description":"Spherocylinder, bifocal, sphere over plus or minus 12.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4379","name":"Urinary plastic pouch w fcpl","description":"Ostomy pouch, urinary, with faceplate attached, plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88387","name":"Macroscopic xm dsj&prep tiss","description":"Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies), each tissue preparation (eg, a single lymph node)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20650","name":"Insert and remove bone pin","description":"Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6691","name":"Removable insert each","description":"Upper extremity addition, removable insert, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72080","name":"X-ray exam thoracolmb 2/> vw","description":"Radiologic examination, spine; thoracolumbar junction, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52282","name":"Cystoscopy implant stent","description":"Cystourethroscopy, with insertion of permanent urethral stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90958","name":"Esrd srv 2-3 vsts p mo 12-19","description":"End-stage renal disease (esrd) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24071","name":"Exc arm/elbow les sc 3 cm/>","description":"Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25130","name":"Removal of wrist lesion","description":"Excision or curettage of bone cyst or benign tumor of carpal bones;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87590","name":"N.gonorrhoeae dna dir prob","description":"Infectious agent detection by nucleic acid (dna or rna); neisseria gonorrhoeae, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57283","name":"Colpopexy intraperitoneal","description":"Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11771","name":"Exc pilonidal cyst xtnsv","description":"Excision of pilonidal cyst or sinus; extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":389.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29040","name":"Appl bdy cst sho to hip head","description":"Application of body cast, shoulder to hips; including head, minerva type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8499","name":"Unlisted misc prosthetic ser","description":"Unlisted procedure for miscellaneous prosthetic services","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27329","name":"Resect thigh/knee tum < 5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":890.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33970","name":"Aortic circulation assist","description":"Insertion of intra-aortic balloon assist device through the femoral artery, open approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0621","name":"Patient lift sling or seat","description":"Sling or seat, patient lift, canvas or nylon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36585","name":"Replace picvad cath","description":"Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":898.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G3002","name":"Chronic pain mgmt 30 mins","description":"Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73040","name":"Contrast x-ray of shoulder","description":"Radiologic examination, shoulder, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0091","name":"Obtaining screen pap smear","description":"Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92317","name":"C-lens fitg tech corneosclrl","description":"Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneoscleral lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63199","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2006.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75893","name":"Venous sampling by catheter","description":"Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43453","name":"Dilate esophagus","description":"Dilation of esophagus, over guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":679.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8628","name":"Cid ext controller repl","description":"Cochlear implant, external controller component, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":602.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86038","name":"Antinuclear antibodies","description":"Antinuclear antibodies (ana);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92928","name":"Prq tcat plmt ntrac st 1 les","description":"Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); 1 lesion involving 1 or more coronary segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":473.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1180","name":"Wheelchair amputee w/ foot r","description":"Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75894","name":"X-rays transcath therapy","description":"Transcatheter therapy, embolization, any method, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45321","name":"Proctosigmoidoscopy volvul","description":"Proctosigmoidoscopy, rigid; with decompression of volvulus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73706","name":"Ct angio lwr extr w/o&w/dye","description":"Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6441","name":"Pad band w>=3in <5in/yd","description":"Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61546","name":"Removal of pituitary gland","description":"Craniotomy for hypophysectomy or excision of pituitary tumor, intracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2118.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01992","name":"Anes dx/ther nrv blk&inj prn","description":"Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); prone position","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75605","name":"Contrast exam thoracic aorta","description":"Aortography, thoracic, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82963","name":"Assay of glucosidase","description":"Glucosidase, beta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26715","name":"Treat knuckle dislocation","description":"Open treatment of metacarpophalangeal dislocation, single, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45320","name":"Proctosigmoidoscopy ablate","description":"Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87255","name":"Genet virus isolate hsv","description":"Virus isolation; including identification by non-immunologic method, other than by cytopathic effect (eg, virus specific enzymatic activity)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74178","name":"Ct abd&plv wo cntr flwd cntr","description":"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55250","name":"Removal of sperm duct(s)","description":"Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27065","name":"Remove hip bone les super","description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; superficial, includes autograft, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32141","name":"Remove/treat lung lesions","description":"Thoracotomy; with resection-plication of bullae, includes any pleural procedure when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43229","name":"Esophagoscopy lesion ablate","description":"Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1906","name":"Afo multilig ank sup pre ots","description":"Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99285","name":"Emergency dept visit hi mdm","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87503","name":"Influenza dna amp prob addl","description":"Infectious agent detection by nucleic acid (dna or rna); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (list separately in addition to code","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75982","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":227.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68815","name":"Probe nasolacrimal duct","description":"Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99466","name":"Ped crit care transport","description":"Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; first 30-74 minutes of hands-on care during transport","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0481","name":"Drug test def 8-14 classes","description":"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44314","name":"Revision of ileostomy","description":"Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":817.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86344","name":"Leukocyte phagocytosis","description":"Leukocyte phagocytosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6244","name":"Hydrogel drg >48 in w/o bdr","description":"Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61500","name":"Crnec exc tum/bone les skull","description":"Craniectomy; with excision of tumor or other bone lesion of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1158.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58562","name":"Hysteroscopy remove fb","description":"Hysteroscopy, surgical; with removal of impacted foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2506","name":"Sgd prerec msg > 40 min","description":"Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22112","name":"Remove part thorax vertebra","description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19272","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1117.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5638","name":"Below knee leather socket","description":"Addition to lower extremity, below knee, leather socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93281","name":"Pm device progr eval multi","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0602","name":"Repl batt silver oxide 3 v","description":"Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6446","name":"Conform band s w>=3in <5in/yd","description":"Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29550","name":"Strapping of toes","description":"Strapping; toes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54550","name":"Exploration for testis","description":"Exploration for undescended testis (inguinal or scrotal area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97605","name":"Neg prs wnd ther dme<=50sqcm","description":"Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (dme), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75894","name":"X-rays transcath therapy","description":"Transcatheter therapy, embolization, any method, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33050","name":"Resect heart sac lesion","description":"Resection of pericardial cyst or tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":868.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77371","name":"Srs multisource","description":"Radiation treatment delivery, stereotactic radiosurgery (srs), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source cobalt 60 based","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2101","name":"Bld glucose monitor w lance","description":"Blood glucose monitor with integrated lancing/blood sample","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63300","name":"Remove vert xdrl body crvcl","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33762","name":"Shunt desc aorta to pulm art","description":"Shunt; descending aorta to pulmonary artery (potts-smith type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1113.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2550","name":"Thigh/wght bear high roll cu","description":"Addition to lower extremity, thigh/weight bearing, high roll cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29870","name":"Arthrs knee dx w/wo syn bx","description":"Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":474.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46710","name":"Repr per/vag pouch sngl proc","description":"Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; transperineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22326","name":"Treat neck spine fracture","description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42235","name":"Repair palate","description":"Repair of anterior palate, including vomer flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":561.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55500","name":"Removal of hydrocele","description":"Excision of hydrocele of spermatic cord, unilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86698","name":"Histoplasma antibody","description":"Antibody; histoplasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87101","name":"Skin fungi culture","description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3916","name":"Who nontorsion jnts pre ots","description":"Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12053","name":"Intmd rpr face/mm 5.1-7.5 cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58520","name":"Repair of ruptured uterus","description":"Hysterorrhaphy, repair of ruptured uterus (nonobstetrical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27040","name":"Biopsy of soft tissues","description":"Biopsy, soft tissue of pelvis and hip area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32603","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7900","name":"Male vacuum erection system","description":"Male vacuum erection system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1083","name":"Hemi-wheelchair fixed arms","description":"Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33463","name":"Valvuloplasty tricuspid","description":"Valvuloplasty, tricuspid valve; without ring insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6402","name":"Sterile gauze <= 16 sq in","description":"Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57415","name":"Remove vaginal foreign body","description":"Removal of impacted vaginal foreign body (separate procedure) under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77011","name":"Ct scan for localization","description":"Computed tomography guidance for stereotactic localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45112","name":"Removal of rectum","description":"Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1489.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43620","name":"Removal of stomach","description":"Gastrectomy, total; with esophagoenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67312","name":"Revise two eye muscles","description":"Strabismus surgery, recession or resection procedure; 2 horizontal muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00160","name":"Anes px nose&sinus nos","description":"Anesthesia for procedures on nose and accessory sinuses; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00950","name":"Anes vag px culdoscopy","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); culdoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5010","name":"Mold socket ank hgt w/ toe f","description":"Partial foot, molded socket, ankle height, with toe filler","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70355","name":"Panoramic x-ray of jaws","description":"Orthopantogram (eg, panoramic x-ray)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00550","name":"Anes for sternal debridement","description":"Anesthesia for sternal debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65222","name":"Remove foreign body from eye","description":"Removal of foreign body, external eye; corneal, with slit lamp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93025","name":"Microvolt t-wave assess","description":"Microvolt t-wave alternans for assessment of ventricular arrhythmias","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61026","name":"Injection into brain canal","description":"Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36216","name":"Place catheter in artery","description":"Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":933.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8900","name":"Mra w/cont, abd","description":"Magnetic resonance angiography with contrast, abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84450","name":"Transferase (ast) (sgot)","description":"Transferase; aspartate amino (ast) (sgot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55535","name":"Revise spermatic cord veins","description":"Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4413","name":"2 pc drainable ost pouch","description":"Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52290","name":"Cystoscopy and treatment","description":"Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86677","name":"Helicobacter pylori antibody","description":"Antibody; helicobacter pylori","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4266","name":"Diaphragm","description":"Diaphragm for contraceptive use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35122","name":"Repair artery rupture belly","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, hepatic, celiac, renal, or mesenteric artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27333","name":"Removal of knee cartilage","description":"Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial and lateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":494.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48150","name":"Partial removal of pancreas","description":"Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (whipple-type procedure); with pancreatojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76001","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77084","name":"Mri bone marrow blood supply","description":"Magnetic resonance (eg, proton) imaging, bone marrow blood supply","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87391","name":"Hiv-2 ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hiv-2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97165","name":"Ot eval low complex 30 min","description":"Occupational therapy evaluation, low complexity, requiring these components: an occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; an assessment(s) that identifies 1-3 performance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93619","name":"Comprehensive ep evaluation","description":"Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, his bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93271","name":"Ecg/monitoring and analysis","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; transmission and analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25295","name":"Release wrist/forearm tendon","description":"Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95982","name":"Io ga n-stim subsq w/reprog","description":"Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70240","name":"X-ray exam pituitary saddle","description":"Radiologic examination, sella turcica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54348","name":"Rpr hypspad comp dsj & urtp","description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); requiring extensive dissection, and urethroplasty with flap, patch or tubed graft (including urinary diversion, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86309","name":"Heterophile antibody titer","description":"Heterophile antibodies; titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38214","name":"Volume deplete of harvest","description":"Transplant preparation of hematopoietic progenitor cells; plasma (volume) depletion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33702","name":"Repair of heart defects","description":"Repair sinus of valsalva fistula, with cardiopulmonary bypass;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0878","name":"Pwc gp4 std sing pow opt cap","description":"Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72120","name":"X-ray bend only l-s spine","description":"Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0303","name":"Hosp bed hvy dty xtra wide","description":"Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8623","name":"Lith ion batt cid,non-earlvl","description":"Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28450","name":"Tx tarsal b1 fx w/o mnpj ea","description":"Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8693","name":"Aud osseo dev, abutment","description":"Auditory osseointegrated device abutment, any length, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33250","name":"Ablate heart dysrhythm focus","description":"Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, wolff-parkinson-white, atrioventricular node re-entry), tract(s) and/or focus (foci); without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21030","name":"Excise max/zygoma b9 tumor","description":"Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":394.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01444","name":"Anes px art knee&pop exc&grf","description":"Anesthesia for procedures on arteries of knee and popliteal area; popliteal excision and graft or repair for occlusion or aneurysm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29260","name":"Strapping of elbow or wrist","description":"Strapping; elbow or wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4723","name":"Dialys sol fld vol > 2999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93970","name":"Extremity study","description":"Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86406","name":"Particle agglut antbdy titr","description":"Particle agglutination; titer, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88271","name":"Cytogenetics dna probe","description":"Molecular cytogenetics; dna probe, each (eg, fish)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29821","name":"Sho arthrs srg compl synvct","description":"Arthroscopy, shoulder, surgical; synovectomy, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":498.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11042","name":"Dbrdmt subq tis 1st 20sqcm/<","description":"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"R0075","name":"Transport port x-ray multipl","description":"Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85611","name":"Prothrombin test","description":"Prothrombin time; substitution, plasma fractions, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33254","name":"Ablate atria lmtd","description":"Operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1170.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84155","name":"Assay of protein serum","description":"Protein, total, except by refractometry; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83992","name":"Assay for phencyclidine","description":"Phencyclidine (pcp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35531","name":"Art byp grft aorcel/aormesen","description":"Bypass graft, with vein; aortoceliac or aortomesenteric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52346","name":"Cystouretero w/renal strict","description":"Cystourethroscopy with ureteroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87003","name":"Small animal inoculation","description":"Animal inoculation, small animal, with observation and dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25830","name":"Arthrd dst rad/ul jt sgm rsc","description":"Arthrodesis, distal radioulnar joint with segmental resection of ulna, with or without bone graft (eg, sauve-kapandji procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":814.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65820","name":"Goniotomy","description":"Goniotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":757.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99170","name":"Anogenital exam child w imag","description":"Anogenital examination, magnified, in childhood for suspected trauma, including image recording when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61548","name":"Removal of pituitary gland","description":"Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89049","name":"Chct for mal hyperthermia","description":"Caffeine halothane contracture test (chct) for malignant hyperthermia susceptibility, including interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0981","name":"Seat upholstery, replacement","description":"Wheelchair accessory, seat upholstery, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0467T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":318.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85246","name":"Clot factor viii vw antigen","description":"Clotting; factor viii, vw factor antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67805","name":"Remove eyelid lesions","description":"Excision of chalazion; multiple, different lids","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64595","name":"Rev/rmv prph sac/gstr npg/r","description":"Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70300","name":"X-ray exam of teeth","description":"Radiologic examination, teeth; single view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55200","name":"Incision of sperm duct","description":"Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":332.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0483","name":"Drug test def 22+ classes","description":"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36147","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":670.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP23","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21143","name":"Rcnstj mdface lefort i 3/>pc","description":"Reconstruction midface, lefort i; 3 or more pieces, segment movement in any direction, without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0198T","name":"Ocular blood flow measure","description":"Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4398","name":"Foot drop splint pre ots","description":"Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47570","name":"Laparo cholecystoenterostomy","description":"Laparoscopy, surgical; cholecystoenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4500","name":"Below knee surgical stocking","description":"Surgical stockings below knee length, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56800","name":"Plastic repair introitus","description":"Plastic repair of introitus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4231","name":"Infusion insulin pump needle","description":"Infusion set for external insulin pump, needle type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8619","name":"Coch imp ext proc/contr rplc","description":"Cochlear implant, external speech processor and controller, integrated system, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2730","name":"Special base curve","description":"Special base curve, glass or plastic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33415","name":"Revision subvalvular tissue","description":"Resection or incision of subvalvular tissue for discrete subvalvular aortic stenosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1830","name":"Adjust toe ext & flex device","description":"Dynamic adjustable toe extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38115","name":"Repair of ruptured spleen","description":"Repair of ruptured spleen (splenorrhaphy) with or without partial splenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":854.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21813","name":"Treatment of rib fracture","description":"Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87510","name":"Gardner vag dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); gardnerella vaginalis, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31605","name":"Emer tracheostomy cthyr mem","description":"Tracheostomy, emergency procedure; cricothyroid membrane","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86803","name":"Hepatitis c ab test","description":"Hepatitis c antibody;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5512","name":"Multi den insert direct form","description":"For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patients foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01939","name":"Anes nulyt agt crv/thrc","description":"Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; cervical or thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01916","name":"Anes dx arteriography/vngrph","description":"Anesthesia for diagnostic arteriography/venography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0103","name":"Psa screening","description":"Prostate cancer screening; prostate specific antigen test (psa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52204","name":"Cystoscopy w/biopsy(s)","description":"Cystourethroscopy, with biopsy(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":310.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77262","name":"Ther radiology tx plng intrm","description":"Therapeutic radiology treatment planning; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1372","name":"Oxy suppl heater for nebuliz","description":"Immersion external heater for nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36251","name":"Ins cath ren art 1st unilat","description":"Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and inte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49900","name":"Repair of abdominal wall","description":"Suture, secondary, of abdominal wall for evisceration or dehiscence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":674.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80048","name":"Basic metabolic pnl total ca","description":"Basic metabolic panel (calcium, total) this panel must include the following: calcium, total (82310) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) potassium (84132) sodium (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2202","name":"Lens sphere bifocal 7.12-20.","description":"Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93566","name":"Njx car cth slctv rv/ra ang","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24115","name":"Exc/crtg b1 cst/tum hum agrf","description":"Excision or curettage of bone cyst or benign tumor, humerus; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33368","name":"Replace aortic valve w/byp","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0084","name":"Care man h v ext pt 60 m","description":"Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75733","name":"Artery x-rays adrenals","description":"Angiography, adrenal, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29049","name":"Appl cast figure-of-eight","description":"Application, cast; figure-of-eight","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93788","name":"Ambl bp mntr w/sw a/r","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; scanning analysis with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6239","name":"Hydrocolld drg > 48 in w/bdr","description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78635","name":"Csf ventriculography","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19305","name":"Mast radical","description":"Mastectomy, radical, including pectoral muscles, axillary lymph nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":761.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74300","name":"X-ray bile ducts/pancreas","description":"Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2212","name":"Lens sphcyl bifo 7.25-12/2.2","description":"Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88355","name":"M/phmtrc alys skeletal musc","description":"Morphometric analysis; skeletal muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35860","name":"Explore limb vessels","description":"Exploration for postoperative hemorrhage, thrombosis or infection; extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6537","name":"Gc stocking full lngth 30-40","description":"Gradient compression stocking, full length/chap style, 30-40 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17000","name":"Destruct premalg lesion","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86003","name":"Allg spec ige crude xtrc ea","description":"Allergen specific ige; quantitative or semiquantitative, crude allergen extract, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62329","name":"Ther spi pnxr csf fluor/ct","description":"Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or ct guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45305","name":"Proctosigmoidoscopy w/bx","description":"Proctosigmoidoscopy, rigid; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27394","name":"Lengthening of thigh tendons","description":"Lengthening of hamstring tendon; multiple tendons, 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01260","name":"Anes all px veins upper leg","description":"Anesthesia for all procedures involving veins of upper leg, including exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86611","name":"Bartonella antibody","description":"Antibody; bartonella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37192","name":"Redo endovas vena cava filtr","description":"Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54690","name":"Laparoscopy orchiectomy","description":"Laparoscopy, surgical; orchiectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73219","name":"Mri upper extremity w/dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":309.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22103","name":"Remove extra spine segment","description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40831","name":"Repair mouth laceration","description":"Closure of laceration, vestibule of mouth; over 2.5 cm or complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65436","name":"Curette/treat cornea","description":"Removal of corneal epithelium; with application of chelating agent (eg, edta)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28420","name":"Optx calcaneal fx w/bone grf","description":"Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2402","name":"Neg press wound therapy pump","description":"Negative pressure wound therapy electrical pump, stationary or portable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26230","name":"Partial removal of hand bone","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":416.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78459","name":"Myocrd img pet single study","description":"Myocardial imaging, positron emission tomography (pet), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54332","name":"Revise penis/urethra","description":"1-stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27540","name":"Treat knee fracture","description":"Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52334","name":"Create passage to kidney","description":"Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73630","name":"X-ray exam of foot","description":"Radiologic examination, foot; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43361","name":"Gastrointestinal repair","description":"Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29848","name":"Wrist endoscopy/surgery","description":"Endoscopy, wrist, surgical, with release of transverse carpal ligament","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":425.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26432","name":"Repair finger tendon","description":"Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet finger)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72255","name":"Myelography thoracic spine","description":"Myelography, thoracic, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33853","name":"Rpr hypopl a-arch w/byp","description":"Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1591.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15941","name":"Exc isch pr ulc prm sut ostc","description":"Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":593.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28047","name":"Resect foot/toe tumor 3 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43450","name":"Dilate esophagus 1/mult pass","description":"Dilation of esophagus, by unguided sound or bougie, single or multiple passes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19357","name":"Tiss xpndr plmt brst rcnstj","description":"Tissue expander placement in breast reconstruction, including subsequent expansion(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":964.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2320","name":"Non-molded lacer","description":"Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31291","name":"Nasal/sinus endoscopy surg","description":"Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid region","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":931.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0329","name":"Electromagntic tx for ulcers","description":"Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4537","name":"Reusable underpad bed size","description":"Incontinence product, protective underpad, reusable, bed size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6660","name":"Heavy duty control cable","description":"Upper extremity addition, heavy duty control cable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29874","name":"Arthrs knee surg rmv loos/fb","description":"Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":452.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00948","name":"Anes vag px crv cerclage","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); cervical cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64809","name":"Sympathectomy thoracolumbar","description":"Sympathectomy, thoracolumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":986.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35476","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1143.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6975","name":"Interscap-thor myoelectronic","description":"Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L1500","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":884.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00604","name":"Anes px crv spn&cord sitting","description":"Anesthesia for procedures on cervical spine and cord; procedures with patient in the sitting position","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5642","name":"Above knee leather socket","description":"Addition to lower extremity, above knee, leather socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":367.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20932","name":"Osteoart algrft w/surf & b1","description":"Allograft, includes templating, cutting, placement and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":593.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15787","name":"Abrasion lesions add-on","description":"Abrasion; each additional 4 lesions or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19083","name":"Bx breast 1st lesion us imag","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38900","name":"Io map of sent lymph node","description":"Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11950","name":"Subq njx filling matrl 1cc/<","description":"Subcutaneous injection of filling material (eg, collagen); 1 cc or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50520","name":"Close kidney-skin fistula","description":"Closure of nephrocutaneous or pyelocutaneous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84160","name":"Assay of protein any source","description":"Protein, total, by refractometry, any source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45393","name":"Colonoscopy w/decompression","description":"Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57531","name":"Removal of cervix radical","description":"Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tube(s), with or without removal of ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1248.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96440","name":"Chmotx admn plrl cav thrcnts","description":"Chemotherapy administration into pleural cavity, requiring and including thoracentesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":668.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6970","name":"Interscapular-thor switch ct","description":"Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4110","name":"Repl leath cuff kafo-afo cal","description":"Replace leather cuff kafo-afo, calf or distal thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7014","name":"Compressor nondispos filter","description":"Filter, nondisposable, used with aerosol compressor or ultrasonic generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54522","name":"Orchiectomy partial","description":"Orchiectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21160","name":"Rcnst mdfc lfrtiii advm w/i","description":"Reconstruction midface, lefort iii (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with lefort i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4406","name":"Pectin based ostomy paste","description":"Ostomy skin barrier, pectin-based, paste, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99358","name":"Prolong service w/o contact","description":"Prolonged evaluation and management service before and/or after direct patient care; first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2121","name":"Lenticular lens, single","description":"Lenticular lens, per lens, single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47532","name":"Injection for cholangiogram","description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; new access (eg, percutaneous transhepatic cholangiogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33963","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21296","name":"Revision of jaw muscle/bone","description":"Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); intraoral approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0633","name":"Lso sc r pos/lat pnl pre cst","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, clo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0204","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29914","name":"Hip arthro w/femoroplasty","description":"Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":837.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01820","name":"Anes clsd px rds u/w/h bones","description":"Anesthesia for all closed procedures on radius, ulna, wrist, or hand bones","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73702","name":"Ct lwr extremity w/o&w/dye","description":"Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33647","name":"Repair heart septum defects","description":"Repair of atrial septal defect and ventricular septal defect, with direct or patch closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1580.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73092","name":"X-ray exam of arm infant","description":"Radiologic examination; upper extremity, infant, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26492","name":"Tendon transfer with graft","description":"Opponensplasty; tendon transfer with graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87904","name":"Phenotype dna hiv w/clt add","description":"Infectious agent phenotype analysis by nucleic acid (dna or rna) with drug resistance tissue culture analysis, hiv 1; each additional drug tested (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62321","name":"Njx interlaminar crv/thrc","description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":207.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86833","name":"Hla class ii high defin qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), hla class ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":162.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01760","name":"Anes opn/arthr elb tot rplct","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; total elbow replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47144","name":"Prep donor liver 3-segment","description":"Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with trisegmen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0241","name":"Bath tub wall rail","description":"Bath tub wall rail, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61797","name":"Srs cran les simple addl","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, simple (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0416","name":"Prostate biopsy, any mthd","description":"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23474","name":"Revis reconst shoulder joint","description":"Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6950","name":"Above elbow switch control","description":"Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4947.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84275","name":"Assay of sialic acid","description":"Sialic acid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11952","name":"Subq njx fil matrl 5.1-10cc","description":"Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80426","name":"Gonadotropin hormone panel","description":"Gonadotropin releasing hormone stimulation panel this panel must include the following: follicle stimulating hormone (fsh) (83001 x 4) luteinizing hormone (lh) (83002 x 4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0246T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":589.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70300","name":"X-ray exam of teeth","description":"Radiologic examination, teeth; single view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26600","name":"Treat metacarpal fracture","description":"Closed treatment of metacarpal fracture, single; without manipulation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78014","name":"Thyroid imaging w/blood flow","description":"Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86901","name":"Blood typing serologic rh(d)","description":"Blood typing, serologic; rh (d)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55540","name":"Revise hernia & sperm veins","description":"Excision of varicocele or ligation of spermatic veins for varicocele; with hernia repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":481.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37249","name":"Trluml balo angiop addl vein","description":"Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86318","name":"Ia infectious agent antibody","description":"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87582","name":"M.pneumon dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); mycoplasma pneumoniae, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82441","name":"Test for chlorohydrocarbons","description":"Chlorinated hydrocarbons, screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34718","name":"Evasc rpr n/a a-iliac ndgft","description":"Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1090.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73060","name":"X-ray exam of humerus","description":"Radiologic examination; humerus, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92614","name":"Laryngoscopic sensory vid","description":"Flexible endoscopic evaluation, laryngeal sensory testing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93298","name":"Rem interrog dev eval scrms","description":"Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0101T","name":"Esw muscskel sys nos","description":"Extracorporeal shock wave involving musculoskeletal system, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83070","name":"Assay of hemosiderin qual","description":"Hemosiderin, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72197","name":"Mri pelvis w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":307.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33602","name":"Closure of valve","description":"Closure of semilunar valve (aortic or pulmonary) by suture or patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1447.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24006","name":"Arthrt elbw capsl exc rls","description":"Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":596.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3660","name":"So 8 ab rstr can/web pre ots","description":"Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79005","name":"Nuclear rx oral admin","description":"Radiopharmaceutical therapy, by oral administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28110","name":"Part removal of metatarsal","description":"Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67208","name":"Treatment of retinal lesion","description":"Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; cryotherapy, diathermy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0104","name":"Ca screen;flexi sigmoidscope","description":"Colorectal cancer screening; flexible sigmoidoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87046","name":"Stool cultr aerobic bact ea","description":"Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99367","name":"Team conf w/o pat by phys","description":"Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74174","name":"Cta abd&plvs w/contrast","description":"Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70542","name":"Mri orbit/face/neck w/dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64480","name":"Njx aa&/strd tfrm epi c/t ea","description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or ct), cervical or thoracic, each additional level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75891","name":"Vein x-ray liver","description":"Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63280","name":"Bx/exc idrl spine lesn crvl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5570","name":"Prep ak ischial direct form","description":"Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49615","name":"Rpr aa hrn rcr 3-10 rdc","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74330","name":"X-ray bile/panc endoscopy","description":"Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82610","name":"Cystatin c","description":"Cystatin c","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56501","name":"Destroy vulva lesions sim","description":"Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80430","name":"Growth hormone panel","description":"Growth hormone suppression panel (glucose administration) this panel must include the following: glucose (82947 x 3) human growth hormone (hgh) (83003 x 4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1355","name":"Oxygen supplies stand/rack","description":"Stand/rack","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97036","name":"App mdlty 1+hubbrd tnk ea 15","description":"Application of a modality to 1 or more areas; hubbard tank, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42120","name":"Remove palate/lesion","description":"Resection of palate or extensive resection of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43196","name":"Esophagoscp guide wire dilat","description":"Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86668","name":"Francisella tularensis","description":"Antibody; francisella tularensis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4389","name":"Drainable pch w st wear barr","description":"Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0485","name":"Monitor cable elec vad, rep","description":"Monitor control cable for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32560","name":"Treat pleurodesis w/agent","description":"Instillation, via chest tube/catheter, agent for pleurodesis (eg, talc for recurrent or persistent pneumothorax)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30435","name":"Revision of nose","description":"Rhinoplasty, secondary; intermediate revision (bony work with osteotomies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1000.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15272","name":"Skin sub graft t/a/l add-on","description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"D1206","name":"Topical fluoride varnish","description":"Topical fluoride varnish; therapeutic application for moderate to high caries risk patients","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7003","name":"Nebulizer administration set","description":"Administration set, with small volume nonfiltered pneumatic nebulizer, disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92081","name":"Limited visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, autoplot, arc perimeter, or single stimulus level automated test, such as octopus 3 or 7 equivalent)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99215","name":"Office o/p est hi 40 min","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 40 minutes must be met or ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92571","name":"Filtered speech test","description":"Filtered speech test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q9955","name":"Inj perflexane lip micros,ml","description":"Injection, perflexane lipid microspheres, per ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78103","name":"Bone marrow imaging mult","description":"Bone marrow imaging; multiple areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52285","name":"Cystoscopy and treatment","description":"Cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp(s) of urethra, bladder neck, and/or ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21610","name":"Costotransversectomy","description":"Costotransversectomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1085.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33977","name":"Remove ventricular device","description":"Removal of ventricular assist device; extracorporeal, single ventricle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27158","name":"Revision of pelvis","description":"Osteotomy, pelvis, bilateral (eg, congenital malformation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74290","name":"Contrast x-ray gallbladder","description":"Cholecystography, oral contrast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93786","name":"Ambl bp mntr w/sw rec only","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; recording only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31230","name":"Removal of upper jaw","description":"Maxillectomy; with orbital exenteration (en bloc)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82726","name":"Long chain fatty acids","description":"Very long chain fatty acids","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2040","name":"Hkafo torsion bil rot straps","description":"Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92516","name":"Facial nerve function test","description":"Facial nerve function studies (eg, electroneuronography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21120","name":"Genioplasty augmentation","description":"Genioplasty; augmentation (autograft, allograft, prosthetic material)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0035","name":"Cardiokymography","description":"Cardiokymography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11960","name":"Insert tissue expander(s)","description":"Insertion of tissue expander(s) for other than breast, including subsequent expansion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":624.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11045","name":"Dbrdmt subq tiss each addl","description":"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51741","name":"Electro-uroflowmetry first","description":"Complex uroflowmetry (eg, calibrated electronic equipment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67340","name":"Revise eye muscle add-on","description":"Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57287","name":"Revise/remove sling repair","description":"Removal or revision of sling for stress incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15115","name":"Epdrm agrft f/s/n/h/f/g/m 1","description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":498.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32653","name":"Thoracoscopy remov fb/fibrin","description":"Thoracoscopy, surgical; with removal of intrapleural foreign body or fibrin deposit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28730","name":"Fusion of foot bones","description":"Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":607.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86038","name":"Antinuclear antibodies","description":"Antinuclear antibodies (ana);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31720","name":"Clearance of airways","description":"Catheter aspiration (separate procedure); nasotracheal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67500","name":"Inject/treat eye socket","description":"Retrobulbar injection; medication (separate procedure, does not include supply of medication)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39502","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":747.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82776","name":"Galactose transferase test","description":"Galactose-1-phosphate uridyl transferase; screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9869","name":"Cmmi asyntelehealth 10-20min","description":"Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20900","name":"Removal of bone for graft","description":"Bone graft, any donor area; minor or small (eg, dowel or button)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L6639","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47100","name":"Wedge biopsy of liver","description":"Biopsy of liver, wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59150","name":"Treat ectopic pregnancy","description":"Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":696.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1700","name":"Jaw motion rehab system","description":"Jaw motion rehabilitation system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61597","name":"Transcondylar approach/skull","description":"Transcondylar (far lateral) approach to posterior cranial fossa, jugular foramen or midline skull base, including occipital condylectomy, mastoidectomy, resection of c1-c3 vertebral body(s), decompression of vertebral artery, with or without mobilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2661.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7401","name":"Add ue prost a/e ultlite mat","description":"Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26478","name":"Lengthening of hand tendon","description":"Lengthening of tendon, flexor, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11771","name":"Exc pilonidal cyst xtnsv","description":"Excision of pilonidal cyst or sinus; extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41872","name":"Gingivoplasty each quadrant","description":"Gingivoplasty, each quadrant (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5782","name":"Hd low limb pros vacuum pump","description":"Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83050","name":"Hgb methemoglobin quan","description":"Hemoglobin; methemoglobin, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61546","name":"Removal of pituitary gland","description":"Craniotomy for hypophysectomy or excision of pituitary tumor, intracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0053","name":"Elevate footrest articulate","description":"Elevating footrests, articulating (telescoping), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36228","name":"Place cath intracranial art","description":"Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (lis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1086.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58700","name":"Removal of fallopian tube","description":"Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2020","name":"Vision svcs frames purchases","description":"Frames, purchases","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19367","name":"Brst rcnstj 1 pdcl tram flap","description":"Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (tram) flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86356","name":"Mononuclear cell antigen","description":"Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99368","name":"Team conf w/o pat by hc pro","description":"Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0190","name":"Positioning cushion","description":"Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87088","name":"Urine bacteria culture","description":"Culture, bacterial; with isolation and presumptive identification of each isolate, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36566","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; with subcutaneous port(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99284","name":"Emergency dept visit mod mdm","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26675","name":"Treat hand dislocation","description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82107","name":"Alpha-fetoprotein l3","description":"Alpha-fetoprotein (afp); afp-l3 fraction isoform and total afp (including ratio)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50555","name":"Kidney endoscopy & biopsy","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":333.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36591","name":"Draw blood off venous device","description":"Collection of blood specimen from a completely implantable venous access device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77317","name":"Brachytx isodose intermed","description":"Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53852","name":"Prostatic rf thermotx","description":"Transurethral destruction of prostate tissue; by radiofrequency thermotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0700","name":"Ctlso a-p-l control molded","description":"Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":941.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34718","name":"Evasc rpr n/a a-iliac ndgft","description":"Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92603","name":"Cochlear implt f/up exam 7/>","description":"Diagnostic analysis of cochlear implant, age 7 years or older; with programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33420","name":"Revision of mitral valve","description":"Valvotomy, mitral valve; closed heart","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01926","name":"Anes ivntl rad icr icar/aort","description":"Anesthesia for therapeutic interventional radiological procedures involving the arterial system; intracranial, intracardiac, or aortic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53410","name":"Reconstruction of urethra","description":"Urethroplasty, 1-stage reconstruction of male anterior urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88380","name":"Microdissection laser","description":"Microdissection (ie, sample preparation of microscopically identified target); laser capture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74480","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78461","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33207","name":"Insert heart pm ventricular","description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP04","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77003","name":"Fluoroguide for spine inject","description":"Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0140","name":"Walker w trunk support","description":"Walker, with trunk support, adjustable or fixed height, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6232","name":"Hydrogel dsg>16<=48 sq in","description":"Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0077","name":"Care manag h vst new pt 30 m","description":"Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43204","name":"Esoph scope w/sclerosis inj","description":"Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99174","name":"Ocular instrumnt screen bil","description":"Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with remote analysis and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01782","name":"Anes vn upr arm&elbw phlbrpy","description":"Anesthesia for procedures on veins of upper arm and elbow; phleborrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0325","name":"Urinal male jug-type","description":"Urinal; male, jug-type, any material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4534","name":"Youth size pull-on","description":"Youth sized disposable incontinence product, protective underwear/pull-on, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22325","name":"Treat spine fracture","description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1284.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20982","name":"Ablate bone tumor(s) perq","description":"Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3102.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99495","name":"Transj care mgmt mod f2f 14d","description":"Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge at least moderate level of medical decision making during the service period face-to-face visit, wit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7502","name":"Replacement diaphragm/fplate","description":"Replacement diaphragm/faceplate for tracheostoma valve, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23130","name":"Acromp/acromionectomy prtl","description":"Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93882","name":"Extracranial uni/ltd study","description":"Duplex scan of extracranial arteries; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23920","name":"Disarticulation shoulder","description":"Disarticulation of shoulder;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46601","name":"Diagnostic anoscopy","description":"Anoscopy; diagnostic, with high-resolution magnification (hra) (eg, colposcope, operating microscope) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64787","name":"Implant nerve end","description":"Implantation of nerve end into bone or muscle (list separately in addition to neuroma excision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75807","name":"Lymph vessel x-ray trunk","description":"Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0814","name":"Pwc gp 1 std port cap chair","description":"Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58340","name":"Catheter for hysterography","description":"Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (sis) or hysterosalpingography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28496","name":"Treat big toe fracture","description":"Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4595","name":"Tens suppl 2 lead per month","description":"Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34490","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":342.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0245","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66711","name":"Ecp ciliary body destruction","description":"Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75741","name":"Artery x-rays lung","description":"Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61608","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; intradural, including dural repair, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88305","name":"Tissue exam by pathologist","description":"Level iv - surgical pathology, gross and microscopic examination abortion - spontaneous/missed artery, biopsy bone marrow, biopsy bone exostosis brain/meninges, other than for tumor resection breast, biopsy, not requiring microscopic evaluation of surgical margins breast, reduction mammoplasty bronc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54690","name":"Laparoscopy orchiectomy","description":"Laparoscopy, surgical; orchiectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":530.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76828","name":"Echo exam of fetal heart","description":"Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26210","name":"Removal of finger lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31513","name":"Injection into vocal cord","description":"Laryngoscopy, indirect; with vocal cord injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98928","name":"Osteopath manj 7-8 regions","description":"Osteopathic manipulative treatment (omt); 7-8 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00860","name":"Anes xtrprtl px lwr abd nos","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1029","name":"W/c vent tray fixed","description":"Wheelchair accessory, ventilator tray, fixed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23515","name":"Optx clavicular fx w/int fix","description":"Open treatment of clavicular fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48155","name":"Removal of pancreas","description":"Pancreatectomy, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1509.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21209","name":"Reduction of facial bones","description":"Osteoplasty, facial bones; reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86635","name":"Coccidioides antibody","description":"Antibody; coccidioides","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0641","name":"Multi-position stnd fram sys","description":"Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24077","name":"Rad rescj tum tiss a/e <5cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76811","name":"Ob us detailed sngl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89300","name":"Semen analysis w/huhner","description":"Semen analysis; presence and/or motility of sperm including huhner test (post coital)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45317","name":"Proctosigmoidoscopy bleed","description":"Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41105","name":"Biopsy of tongue","description":"Biopsy of tongue; posterior one-third","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38790","name":"Inject for lymphatic x-ray","description":"Injection procedure; lymphangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95806","name":"Sleep study unatt&resp efft","description":"Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2520","name":"Th/wght bear quad-lat brim c","description":"Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30630","name":"Repair nasal septum defect","description":"Repair nasal septal perforations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":484.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99402","name":"Prev med cnsl indiv apprx 30","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6229","name":"Gauze >16<=48 sq in watr/sal","description":"Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0086","name":"Care man home care plan 30 m","description":"Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68440","name":"Snip inc lacrimal punctum","description":"Snip incision of lacrimal punctum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95961","name":"Electrode stimulation brain","description":"Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61626","name":"Tcat perm occls/embol noncns","description":"Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), including all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention, percutaneous,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85250","name":"Clot factor ix ptc/chrstmas","description":"Clotting; factor ix (ptc or christmas)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61624","name":"Tcat perm occls/embolj cns","description":"Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), including all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention, percutaneous,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47720","name":"Fuse gallbladder & bowel","description":"Cholecystoenterostomy; direct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62368","name":"Analyze sp inf pump w/reprog","description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87542","name":"Legion pneumo dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); legionella pneumophila, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77776","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":359.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61522","name":"Removal of brain abscess","description":"Craniectomy, infratentorial or posterior fossa; for excision of brain abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91300","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88182","name":"Cell marker study","description":"Flow cytometry, cell cycle or dna analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27087","name":"Remove hip foreign body","description":"Removal of foreign body, pelvis or hip; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4103","name":"Ef ped fluid and electrolyte","description":"Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61333","name":"Expl orbit w/removal lesion","description":"Exploration of orbit (transcranial approach), with removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1854.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32550","name":"Insert pleural cath","description":"Insertion of indwelling tunneled pleural catheter with cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":589.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97163","name":"Pt eval high complex 45 min","description":"Physical therapy evaluation: high complexity, requiring these components: a history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; an examination of body systems using standardized tests and measures addressing a total of 4 or more elements from","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77770","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87290","name":"Varicella zoster ag if","description":"Infectious agent antigen detection by immunofluorescent technique; varicella zoster virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11621","name":"Exc s/n/h/f/g mal+mrg 0.6-1","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65810","name":"Drainage of eye","description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48100","name":"Biopsy of pancreas open","description":"Biopsy of pancreas, open (eg, fine needle aspiration, needle core biopsy, wedge biopsy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27429","name":"Reconstruction knee","description":"Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1060.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31500","name":"Insert emergency airway","description":"Intubation, endotracheal, emergency procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0840","name":"Pwc gp2 xhd sing pow opt s/b","description":"Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35301","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58543","name":"Lsh uterus above 250 g","description":"Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50340","name":"Recipient nephrectomy","description":"Recipient nephrectomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":826.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82274","name":"Assay test for blood fecal","description":"Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44602","name":"Suture small intestine","description":"Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92538","name":"Caloric vstblr test w/rec","description":"Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1392","name":"Portable oxygen concentrator","description":"Portable oxygen concentrator, rental","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4615","name":"Cannula nasal","description":"Cannula, nasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64736","name":"Incision of chin nerve","description":"Transection or avulsion of; mental nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27730","name":"Repair of tibia epiphysis","description":"Arrest, epiphyseal (epiphysiodesis), open; distal tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63700","name":"Repair of spinal herniation","description":"Repair of meningocele; less than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1184.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97034","name":"App mdlty 1+cntrst bth ea 15","description":"Application of a modality to 1 or more areas; contrast baths, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6241","name":"Hydrocolloid drg filler dry","description":"Hydrocolloid dressing, wound filler, dry form, sterile, per gram","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25622","name":"Cltx carpl scphd fx w/o mnpj","description":"Closed treatment of carpal scaphoid (navicular) fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63650","name":"Implant neuroelectrodes","description":"Percutaneous implantation of neurostimulator electrode array, epidural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27391","name":"Incision of thigh tendons","description":"Tenotomy, open, hamstring, knee to hip; multiple tendons, 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76856","name":"Us exam pelvic complete","description":"Ultrasound, pelvic (nonobstetric), real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49255","name":"Removal of omentum","description":"Omentectomy, epiploectomy, resection of omentum (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33777","name":"Rpr tga bfl rpr sbpulm obstr","description":"Repair of transposition of the great arteries, atrial baffle procedure (eg, mustard or senning type) with cardiopulmonary bypass; with repair of subpulmonic obstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80051","name":"Electrolyte panel","description":"Electrolyte panel this panel must include the following: carbon dioxide (bicarbonate) (82374) chloride (82435) potassium (84132) sodium (84295)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11971","name":"Rmvl tis xpndr wo insj implt","description":"Removal of tissue expander without insertion of implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87107","name":"Fungi identification mold","description":"Culture, fungi, definitive identification, each organism; mold","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39530","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":715.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8320","name":"Truss addition to std pad wa","description":"Truss, addition to standard pad, water pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15150","name":"Tis cltr skn agrft t/a/l 1st","description":"Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":465.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0459","name":"Chest wrap","description":"Chest wrap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58670","name":"Laparoscopy tubal cautery","description":"Laparoscopy, surgical; with fulguration of oviducts (with or without transection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99233","name":"Sbsq hosp ip/obs high 50","description":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 50 minutes m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43260","name":"Ercp w/specimen collection","description":"Endoscopic retrograde cholangiopancreatography (ercp); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23490","name":"Reinforce clavicle","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":728.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74185","name":"Mra abd w or w/o cntrst","description":"Magnetic resonance angiography, abdomen, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":306.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26200","name":"Remove hand bone lesion","description":"Excision or curettage of bone cyst or benign tumor of metacarpal;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70547","name":"Mr angiography neck w/o dye","description":"Magnetic resonance angiography, neck; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84285","name":"Assay of silica","description":"Silica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82541","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38300","name":"Drainage lymph node lesion","description":"Drainage of lymph node abscess or lymphadenitis; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1020","name":"Residual limb support system","description":"Residual limb support system for wheelchair, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15740","name":"Island pedicle flap graft","description":"Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85461","name":"Hemoglobin fetal","description":"Hemoglobin or rbcs, fetal, for fetomaternal hemorrhage; rosette","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51702","name":"Insert temp bladder cath","description":"Insertion of temporary indwelling bladder catheter; simple (eg, foley)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21235","name":"Ear cartilage graft","description":"Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78608","name":"Brain imaging (pet)","description":"Brain imaging, positron emission tomography (pet); metabolic evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1192.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32225","name":"Partial release of lung","description":"Decortication, pulmonary (separate procedure); partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37615","name":"Ligation major artery neck","description":"Ligation, major artery (eg, post-traumatic, rupture); neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76937","name":"Us guide vascular access","description":"Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (list separately in addition to code for primary ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77032","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21343","name":"Open tx dprsd front sinus fx","description":"Open treatment of depressed frontal sinus fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43276","name":"Ercp stent exchange w/dilate","description":"Endoscopic retrograde cholangiopancreatography (ercp); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86359","name":"T cells total count","description":"T cells; total count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78122","name":"Whl bld volume determination","description":"Whole blood volume determination, including separate measurement of plasma volume and red cell volume (radiopharmaceutical volume-dilution technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78802","name":"Rp loclzj tum whbdy 1 d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0478","name":"Power adapter, combo vad","description":"Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50080","name":"Perq nl/pl lithotrp smpl<2cm","description":"Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (eg, stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching ston","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93631","name":"Ntraop epicar&endcar pac&map","description":"Intra-operative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical correction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00916","name":"Anes trurl px rescj bleeding","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); post-transurethral resection bleeding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54326","name":"Reconstruction of urethra","description":"1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps and mobilization of urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87562","name":"M.avium-intra dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria avium-intracellulare, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35585","name":"Vein byp fem-tibial peroneal","description":"In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1478.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26990","name":"Drainage of pelvis lesion","description":"Incision and drainage, pelvis or hip joint area; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0920","name":"Fracture frame attached to b","description":"Fracture frame, attached to bed, includes weights","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0512","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64490","name":"Inj paravert f jnt c/t 1 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), cervical or thoracic; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33241","name":"Remove pulse generator","description":"Removal of implantable defibrillator pulse generator only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86729","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92012","name":"Intrm oph exam est patient","description":"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97535","name":"Self care mngment training","description":"Self-care/home management training (eg, activities of daily living (adl) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88331","name":"Path consltj surg 1 blk 1spc","description":"Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6624","name":"Flex/ext/rotation wrist unit","description":"Upper extremity addition, flexion/extension and rotation wrist unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1874","name":"Stent, coated/cov w/del sys","description":"Stent, coated/covered, with delivery system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3310.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25676","name":"Optx rad/uln dislc aqt/chrnc","description":"Open treatment of distal radioulnar dislocation, acute or chronic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84520","name":"Assay of urea nitrogen","description":"Urea nitrogen; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85018","name":"Hemoglobin","description":"Blood count; hemoglobin (hgb)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87472","name":"Bartonella dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); bartonella henselae and bartonella quintana, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27614","name":"Biopsy lower leg soft tissue","description":"Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93923","name":"Upr/lxtr art stdy 3+ lvls","description":"Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional doppler wave","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2251","name":"Brief chkin, 5-10, non-e/m","description":"Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15758","name":"Free fascial flap microvasc","description":"Free fascial flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1456.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82017","name":"Acylcarnitines quant","description":"Acylcarnitines; quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96365","name":"Ther/proph/diag iv inf init","description":"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7028","name":"Repl oral cushion combo mask","description":"Oral cushion for combination oral/nasal mask, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77078","name":"Ct bone density axial","description":"Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7044","name":"Pap oral interface","description":"Oral interface used with positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0159","name":"Brake for wheeled walker","description":"Brake attachment for wheeled walker, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23182","name":"Prtl excision bone scapula","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), scapula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP05","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76946","name":"Echo guide for amniocentesis","description":"Ultrasonic guidance for amniocentesis, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28313","name":"Repair deformity of toe","description":"Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78431","name":"Myocrd img pet rst&strs ct","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26390","name":"Revise hand/finger tendon","description":"Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":712.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31256","name":"Exploration maxillary sinus","description":"Nasal/sinus endoscopy, surgical, with maxillary antrostomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71090","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0609","name":"Repl electrode for aed","description":"Replacement electrodes for use with automated external defibrillator, garment type only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":466.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5979","name":"Multi-axial ankle/ft prosth","description":"All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1132.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39560","name":"Resect diaphragm simple","description":"Resection, diaphragm; with simple repair (eg, primary suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":687.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97552","name":"Group caregiver training","description":"Group caregiver training in strategies and techniques to facilitate the patients functional performance in the home or community (eg, activities of daily living [adls], instrumental adls [iadls], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93980","name":"Penile vascular study","description":"Duplex scan of arterial inflow and venous outflow of penile vessels; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27600","name":"Decompression of lower leg","description":"Decompression fasciotomy, leg; anterior and/or lateral compartments only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98961","name":"Edu&trn pt slf-mgmt nqhp 2-4","description":"Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35879","name":"Revise graft w/vein","description":"Revision, lower extremity arterial bypass, without thrombectomy, open; with vein patch angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":814.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25575","name":"Optx rdl&uln shft fx rds&uln","description":"Open treatment of radial and ulnar shaft fractures, with internal fixation, when performed; of radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5845","name":"Knee-shin sys stance flexion","description":"Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":873.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83527","name":"Assay of insulin","description":"Insulin; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71048","name":"X-ray exam chest 4+ views","description":"Radiologic examination, chest; 4 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36557","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84437","name":"Assay of neonatal thyroxine","description":"Thyroxine; requiring elution (eg, neonatal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15835","name":"Exc excessive skin buttock","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24065","name":"Biopsy arm/elbow soft tissue","description":"Biopsy, soft tissue of upper arm or elbow area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34717","name":"Evasc rpr a-iliac ndgft","description":"Endovascular repair of iliac artery at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpret","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87430","name":"Strep a ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; streptococcus, group a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28305","name":"Incise/graft midfoot bones","description":"Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes obtaining graft) (eg, fowler type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":544.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30920","name":"Ligation upper jaw artery","description":"Ligation arteries; internal maxillary artery, transantral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92627","name":"Eval aud funcj ea addl 15","description":"Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7029","name":"Repl nasal pillow comb mask","description":"Nasal pillows for combination oral/nasal mask, replacement only, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71550","name":"Mri chest w/o dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":239.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46500","name":"Injection into hemorrhoid(s)","description":"Injection of sclerosing solution, hemorrhoids","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26449","name":"Release forearm/hand tendon","description":"Tenolysis, complex, extensor tendon, finger, including forearm, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72020","name":"X-ray exam of spine 1 view","description":"Radiologic examination, spine, single view, specify level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72110","name":"X-ray exam l-2 spine 4/>vws","description":"Radiologic examination, spine, lumbosacral; minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0849","name":"Cervical pneum trac equip","description":"Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25565","name":"Cltx rdl&uln shft fx w/mnpj","description":"Closed treatment of radial and ulnar shaft fractures; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":431.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98940","name":"Chiropract manj 1-2 regions","description":"Chiropractic manipulative treatment (cmt); spinal, 1-2 regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85525","name":"Heparin neutralization","description":"Heparin neutralization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26554","name":"Double transfer toe-hand","description":"Transfer, toe-to-hand with microvascular anastomosis; other than great toe, double","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70310","name":"X-ray exam of teeth","description":"Radiologic examination, teeth; partial examination, less than full mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33974","name":"Remove intra-aortic balloon","description":"Removal of intra-aortic balloon assist device from the ascending aorta, including repair of the ascending aorta, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":767.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88312","name":"Special stains group 1","description":"Special stain including interpretation and report; group i for microorganisms (eg, acid fast, methenamine silver)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46948","name":"Int hrhc tranal dartlzj 2+","description":"Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49442","name":"Place cecostomy tube perc","description":"Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33688","name":"Clsr 1vsd w/wo ptch rmvl bnd","description":"Closure of single ventricular septal defect, with or without patch; with removal of pulmonary artery band, with or without gusset","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1610","name":"Ho frejka cov only pre cst","description":"Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64420","name":"Njx aa&/strd ntrcost nrv 1","description":"Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85445","name":"Heinz bodies induced","description":"Heinz bodies; induced, acetyl phenylhydrazine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88199","name":"Unlisted cytopathology px","description":"Unlisted cytopathology procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99347","name":"Home/res vst est sf mdm 20","description":"Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 20 minutes must be met or exceede","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5654","name":"Socket insert symes","description":"Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36902","name":"Intro cath dialysis circuit","description":"Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61782","name":"Scan proc cranial extra","description":"Stereotactic computer-assisted (navigational) procedure; cranial, extradural (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82951","name":"Glucose tolerance test (gtt)","description":"Glucose; tolerance test (gtt), 3 specimens (includes glucose)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77767","name":"Hdr rdncl skn surf brachytx","description":"Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27550","name":"Treat knee dislocation","description":"Closed treatment of knee dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33991","name":"Insj perq vad l hrt artl&ven","description":"Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":540.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32098","name":"Open biopsy of lung pleura","description":"Thoracotomy, with biopsy(ies) of pleura","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49220","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":814.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96110","name":"Developmental screen w/score","description":"Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27030","name":"Arthrotomy hip w/drainage","description":"Arthrotomy, hip, with drainage (eg, infection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28302","name":"Incision of ankle bone","description":"Osteotomy; talus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45562","name":"Exploration/repair of rectum","description":"Exploration, repair, and presacral drainage for rectal injury;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":920.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19283","name":"Perq dev breast 1st strtctc","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85002","name":"Bleeding time test","description":"Bleeding time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42665","name":"Ligation of salivary duct","description":"Ligation salivary duct, intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83718","name":"Assay of lipoprotein","description":"Lipoprotein, direct measurement; high density cholesterol (hdl cholesterol)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76945","name":"Echo guide villus sampling","description":"Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69740","name":"Repair facial nerve","description":"Suture facial nerve, intratemporal, with or without graft or decompression; lateral to geniculate ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85046","name":"Reticyte/hgb concentrate","description":"Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content [chr], immature reticulocyte fraction [irf], reticulocyte volume [mrv], rna content), direct measurement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50593","name":"Perc cryo ablate renal tum","description":"Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67924","name":"Repair eyelid defect","description":"Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95004","name":"Perq tests w/alrgnc xtrcs","description":"Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27257","name":"Treat hip dislocation","description":"Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; with manipulation, requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66825","name":"Reposition intraocular lens","description":"Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28344","name":"Repair extra toe(s)","description":"Reconstruction, toe(s); polydactyly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59830","name":"Treat uterus infection","description":"Treatment of septic abortion, completed surgically","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1120","name":"Covers for upright each","description":"Addition to ctlso, scoliosis orthosis, cover for upright, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11104","name":"Punch bx skin single lesion","description":"Punch biopsy of skin (including simple closure, when performed); single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33774","name":"Rpr tga atrial baffle px","description":"Repair of transposition of the great arteries, atrial baffle procedure (eg, mustard or senning type) with cardiopulmonary bypass;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1561.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95872","name":"Ndl emg single fiber eltrd","description":"Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20962","name":"Other bone graft microvasc","description":"Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2254.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0120","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6539","name":"Gc stocking waistlngth 18-30","description":"Gradient compression stocking, waist length, 18-30 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71046","name":"X-ray exam chest 2 views","description":"Radiologic examination, chest; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45135","name":"Excision of rectal prolapse","description":"Excision of rectal procidentia, with anastomosis; abdominal and perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1007.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92564","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00938","name":"Anes insj penile prosthesis","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); insertion of penile prosthesis (perineal approach)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01160","name":"Anes clsd px symph pub/si jt","description":"Anesthesia for closed procedures involving symphysis pubis or sacroiliac joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59074","name":"Fetal fluid drainage w/us","description":"Fetal fluid drainage (eg, vesicocentesis, thoracocentesis, paracentesis), including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82947","name":"Assay glucose blood quant","description":"Glucose; quantitative, blood (except reagent strip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1240","name":"Whchr litwt det arm leg rest","description":"Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87529","name":"Hsv dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); herpes simplex virus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0652","name":"Pneum compres w/cal pressure","description":"Pneumatic compressor, segmental home model with calibrated gradient pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4157","name":"Ef special metabolic inherit","description":"Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31592","name":"Cricotracheal resection","description":"Cricotracheal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1287.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21150","name":"Rcnstj mdfc lefrtii ant ntru","description":"Reconstruction midface, lefort ii; anterior intrusion (eg, treacher-collins syndrome)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14061","name":"Tis trnfr e/n/e/l10.1-30sqcm","description":"Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0464","name":"Tlso 4mod sacro-scap pre","description":"Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, corona","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27882","name":"Amputation of lower leg","description":"Amputation, leg, through tibia and fibula; open, circular (guillotine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":518.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51020","name":"Cystotomy/cystostomy w/fulg","description":"Cystotomy or cystostomy, with fulguration and/or insertion of radioactive material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94011","name":"Spirometry up to 2 yrs old","description":"Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52330","name":"Cystoscopy and treatment","description":"Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27686","name":"Revise lower leg tendons","description":"Lengthening or shortening of tendon, leg or ankle; multiple tendons (through same incision), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2366","name":"Battery charger, single mode","description":"Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5683","name":"Initial custom socket insert","description":"Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76886","name":"Us exam infant hips static","description":"Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92986","name":"Revision of aortic valve","description":"Percutaneous balloon valvuloplasty; aortic valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0404","name":"Ekg tracing for initial prev","description":"Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26776","name":"Pin finger dislocation","description":"Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":371.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87592","name":"N.gonorrhoeae dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); neisseria gonorrhoeae, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95813","name":"Eeg extnd mntr 61-119 min","description":"Electroencephalogram (eeg) extended monitoring; 61-119 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46020","name":"Placement of seton","description":"Placement of seton","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0636","name":"Lso sagittal rigid panel cus","description":"Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6672","name":"Harness chest/shlder saddle","description":"Upper extremity addition, harness, chest or shoulder, saddle type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61210","name":"Burr hole implt ventr cath","description":"Burr hole(s); for implanting ventricular catheter, reservoir, eeg electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91040","name":"Esoph balloon distension tst","description":"Esophageal balloon distension study, diagnostic, with provocation when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45355","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35311","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; subclavian, innominate, by thoracic incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37230","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5095.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11301","name":"Shave skin lesion 0.6-1.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82131","name":"Amino acids single quant","description":"Amino acids; single, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78811","name":"Pet image ltd area","description":"Positron emission tomography (pet) imaging; limited area (eg, chest, head/neck)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1061.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50561","name":"Kidney endoscopy & treatment","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99195","name":"Phlebotomy","description":"Phlebotomy, therapeutic (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50590","name":"Fragmenting of kidney stone","description":"Lithotripsy, extracorporeal shock wave","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78003","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4185","name":"Pn soln nos 10 grams lipids","description":"Parenteral nutrition solution, not otherwise specified, 10 grams lipids","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86625","name":"Campylobacter antibody","description":"Antibody; campylobacter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5940","name":"Endo bk ultra-light material","description":"Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0091","name":"Obtaining screen pap smear","description":"Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01392","name":"Anes opn px upr tib fib&/pat","description":"Anesthesia for all open procedures on upper ends of tibia, fibula, and/or patella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45341","name":"Sigmoidoscopy w/ultrasound","description":"Sigmoidoscopy, flexible; with endoscopic ultrasound examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87400","name":"Influenza a/b each ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; influenza, a or b, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93701","name":"Bioimpedance cv analysis","description":"Bioimpedance-derived physiologic cardiovascular analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24115","name":"Exc/crtg b1 cst/tum hum agrf","description":"Excision or curettage of bone cyst or benign tumor, humerus; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":622.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78832","name":"Rp loclzj tum spect w/ct 2","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect) with concurrently acquired computed tomography (ct) transmission scan for anatomical review, localizati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45520","name":"Treatment of rectal prolapse","description":"Perirectal injection of sclerosing solution for prolapse","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99225","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49010","name":"Exploration behind abdomen","description":"Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":763.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35875","name":"Removal of clot in graft","description":"Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66989","name":"Xcpsl ctrc rmvl cplx insj 1+","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":500.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86774","name":"Tetanus antibody","description":"Antibody; tetanus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67121","name":"Remove eye implant material","description":"Removal of implanted material, posterior segment; intraocular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42104","name":"Excision lesion mouth roof","description":"Excision, lesion of palate, uvula; without closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57425","name":"Laparoscopy surg colpopexy","description":"Laparoscopy, surgical, colpopexy (suspension of vaginal apex)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":622.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77771","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81443","name":"Genetic tstg severe inh cond","description":"Genetic testing for severe inherited conditions (eg, cystic fibrosis, ashkenazi jewish-associated disorders [eg, bloom syndrome, canavan disease, fanconi anemia type c, mucolipidosis type vi, gaucher disease, tay-sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1224.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33221","name":"Insert pulse gen mult leads","description":"Insertion of pacemaker pulse generator only; with existing multiple leads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":311.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42660","name":"Dilation of salivary duct","description":"Dilation and catheterization of salivary duct, with or without injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9487","name":"Remote e/m est. pt 15mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5652","name":"Suction susp ak/knee disart","description":"Addition to lower extremity, suction suspension, above knee or knee disarticulation socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21501","name":"I&d dp absc/hmtma sft ts nck","description":"Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":388.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49906","name":"Free omental flap microvasc","description":"Free omental flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":878.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70190","name":"X-ray exam of eye sockets","description":"Radiologic examination; optic foramina","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62269","name":"Needle biopsy spinal cord","description":"Biopsy of spinal cord, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0076T","name":"S&i stent/chest vert art","description":"Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; each additional vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1811","name":"Sps/pass knee device","description":"Static progressive stretch/patient actualized serial stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0214T","name":"Njx paravert w/us cer/thor","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39560","name":"Resect diaphragm simple","description":"Resection, diaphragm; with simple repair (eg, primary suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4418","name":"Ost pch clsd w/o bar w filtr","description":"Ostomy pouch, closed; without barrier attached, with filter (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72074","name":"X-ray exam thorac spine4/>vw","description":"Radiologic examination, spine; thoracic, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74261","name":"Ct colonography dx","description":"Computed tomographic (ct) colonography, diagnostic, including image postprocessing; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82787","name":"Igg 1 2 3 or 4 each","description":"Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, igg1, 2, 3, or 4), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78428","name":"Cardiac shunt imaging","description":"Cardiac shunt detection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88377","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27659","name":"Repair of leg tendon each","description":"Repair, flexor tendon, leg; secondary, with or without graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61534","name":"Removal of brain lesion","description":"Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32400","name":"Needle biopsy chest lining","description":"Biopsy, pleura, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31070","name":"Exploration of frontal sinus","description":"Sinusotomy frontal; external, simple (trephine operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19271","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1023.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6650","name":"Shoulder universal joint","description":"Upper extremity addition, shoulder universal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39200","name":"Resect mediastinal cyst","description":"Resection of mediastinal cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30901","name":"Control of nosebleed","description":"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21123","name":"Geniop sldg augmentation","description":"Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49002","name":"Reopening of abdomen","description":"Reopening of recent laparotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":868.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85246","name":"Clot factor viii vw antigen","description":"Clotting; factor viii, vw factor antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7526","name":"Tracheostomy tube collar","description":"Tracheostomy tube collar/holder, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44050","name":"Reduce bowel obstruction","description":"Reduction of volvulus, intussusception, internal hernia, by laparotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":779.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26412","name":"Repair/graft hand tendon","description":"Repair, extensor tendon, hand, primary or secondary; with free graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":569.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28043","name":"Exc foot/toe tum sc < 1.5 cm","description":"Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33786","name":"Repair arterial trunk","description":"Total repair, truncus arteriosus (rastelli type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1984.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34802","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1056.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21931","name":"Exc back les sc 3 cm/>","description":"Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":405.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95125","name":"Immunotherapy 2/> injections","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 or more injections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76812","name":"Ob us detailed addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86850","name":"Rbc antibody screen","description":"Antibody screen, rbc, each serum technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28291","name":"Corrj halux rigdus w/implt","description":"Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":589.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49060","name":"Drain open retroperi abscess","description":"Drainage of retroperitoneal abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47553","name":"Biliary endoscopy thru skin","description":"Biliary endoscopy, percutaneous via t-tube or other tract; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86628","name":"Candida antibody","description":"Antibody; candida","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28124","name":"Partial removal of toe","description":"Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4434","name":"Ost pch urine w lock flng/ft","description":"Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28107","name":"Remove/graft foot lesion","description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":409.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4388","name":"Drainable pch w ex wear barr","description":"Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96374","name":"Ther/proph/diag inj iv push","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1710","name":"Legg perthes orth newington","description":"Legg perthes orthosis, (newington type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69637","name":"Rebuild eardrum structures","description":"Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [porp], total ossicular replacement prosthesis [torp])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26645","name":"Treat thumb fracture","description":"Closed treatment of carpometacarpal fracture dislocation, thumb (bennett fracture), with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6320","name":"Shoulder passive restor cap","description":"Shoulder disarticulation, passive restoration (shoulder cap only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0182","name":"Replace pump, alt press pad","description":"Pump for alternating pressure pad, for replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33670","name":"Repair of heart chambers","description":"Repair of complete atrioventricular canal, with or without prosthetic valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1719.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92576","name":"Synthetic sentence id test","description":"Synthetic sentence identification test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95249","name":"Cont gluc mntr pt prov eqp","description":"Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22830","name":"Exploration of spinal fusion","description":"Exploration of spinal fusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":715.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0215","name":"Electric heat pad moist","description":"Electric heat pad, moist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44202","name":"Lap enterectomy","description":"Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55060","name":"Repair of hydrocele","description":"Repair of tunica vaginalis hydrocele (bottle type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64885","name":"Nerve graft head/neck <4 cm","description":"Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11450","name":"Exc skn hdrdnt ax smpl/ntrm","description":"Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78351","name":"Bone mineral dual photon","description":"Bone density (bone mineral content) study, 1 or more sites; dual photon absorptiometry, 1 or more sites","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L7266","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0326","name":"Urinal female jug-type","description":"Urinal; female, jug-type, any material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88364","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69209","name":"Remove impacted ear wax uni","description":"Removal impacted cerumen using irrigation/lavage, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23935","name":"Inc dp opn b1 crtx hum/elbw","description":"Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), humerus or elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0162","name":"Sitz bath chair","description":"Sitz bath chair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43632","name":"Removal of stomach partial","description":"Gastrectomy, partial, distal; with gastrojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91010","name":"Esophagus motility study","description":"Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78608","name":"Brain imaging (pet)","description":"Brain imaging, positron emission tomography (pet); metabolic evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95700","name":"Eeg cont rec w/vid eeg tech","description":"Electroencephalogram (eeg) continuous recording, with video when performed, setup, patient education, and takedown when performed, administered in person by eeg technologist, minimum of 8 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15952","name":"Exc trchntr pr ulc flp clsr","description":"Excision, trochanteric pressure ulcer, with skin flap closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78761","name":"Testicular imaging w/flow","description":"Testicular imaging with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93452","name":"Left hrt cath w/ventrclgrphy","description":"Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69210","name":"Remove impacted ear wax uni","description":"Removal impacted cerumen requiring instrumentation, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27501","name":"Treatment of thigh fracture","description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":424.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31288","name":"Nasal/sinus endoscopy surg","description":"Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43260","name":"Ercp w/specimen collection","description":"Endoscopic retrograde cholangiopancreatography (ercp); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76512","name":"Oph us dx b-scan","description":"Ophthalmic ultrasound, diagnostic; b-scan (with or without superimposed non-quantitative a-scan)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43611","name":"Excision of stomach lesion","description":"Excision, local; malignant tumor of stomach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25624","name":"Cltx carpl scphd fx w/mnpj","description":"Closed treatment of carpal scaphoid (navicular) fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21012","name":"Exc face les sbq 2 cm/>","description":"Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76802","name":"Ob us < 14 wks addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58565","name":"Hysteroscopy sterilization","description":"Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29130","name":"Appl finger splint static","description":"Application of finger splint; static","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25275","name":"Repair forearm tendon sheath","description":"Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":561.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43261","name":"Endo cholangiopancreatograph","description":"Endoscopic retrograde cholangiopancreatography (ercp); with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84578","name":"Test urine urobilinogen","description":"Urobilinogen, urine; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34701","name":"Evasc rpr a-ao ndgft","description":"Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85547","name":"Rbc mechanical fragility","description":"Mechanical fragility, rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0324","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35281","name":"Rpr blvsl gr ot/th vn ntr-ab","description":"Repair blood vessel with graft other than vein; intra-abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1428.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52240","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; large bladder tumor(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33031","name":"Partial removal of heart sac","description":"Pericardiectomy, subtotal or complete; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2153.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0870","name":"Tract frame attach footboard","description":"Traction frame, attached to footboard, extremity traction, (e.g., bucks)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31717","name":"Bronchial brush biopsy","description":"Catheterization with bronchial brush biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92627","name":"Eval aud funcj ea addl 15","description":"Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0123","name":"Screen cerv/vag thin layer","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0638","name":"Lso sag-coronal panel custom","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3935","name":"Fo nontorsion joint cf","description":"Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54344","name":"Rrp hypspad comp moblj&urtp","description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); requiring mobilization of skin flaps and urethroplasty with flap or patch graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":765.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2034","name":"Kafo pla sin up w/wo k/a cus","description":"Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1013.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0957","name":"W/c medial thigh support","description":"Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15275","name":"Skin sub graft face/nk/hf/g","description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87803","name":"Clostridium toxin a w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; clostridium difficile toxin a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95808","name":"Polysom any age 1-3> param","description":"Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88365","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87272","name":"Cryptosporidium ag if","description":"Infectious agent antigen detection by immunofluorescent technique; cryptosporidium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6220","name":"Gauze >16 <=48 sq in w/bordr","description":"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54600","name":"Reduce testis torsion","description":"Reduction of torsion of testis, surgical, with or without fixation of contralateral testis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1802","name":"Adjst forearm pro/sup device","description":"Dynamic adjustable forearm pronation/supination device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35082","name":"Repair artery rupture aorta","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97802","name":"Medical nutrition indiv in","description":"Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64627","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43215","name":"Esophagoscopy flex remove fb","description":"Esophagoscopy, flexible, transoral; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40845","name":"Reconstruction of mouth","description":"Vestibuloplasty; complex (including ridge extension, muscle repositioning)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47001","name":"Ndl biopsy lvr tm oth maj px","description":"Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82627","name":"Dehydroepiandrosterone","description":"Dehydroepiandrosterone-sulfate (dhea-s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43335","name":"Transthor diaphrag hern rpr","description":"Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1109.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23107","name":"Arthrt glenhumrl jt w/expl","description":"Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54060","name":"Excision of penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01215","name":"Anes opn revj tot hip arthrp","description":"Anesthesia for open procedures involving hip joint; revision of total hip arthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31573","name":"Largsc w/ther injection","description":"Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54164","name":"Frenulotomy of penis","description":"Frenulotomy of penis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12005","name":"Rpr s/n/a/gen/trk12.6-20.0cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0406","name":"Inpt/tele follow up 15","description":"Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56515","name":"Destroy vulva lesion/s compl","description":"Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30545","name":"Rpr choanal atresia trsnpltn","description":"Repair choanal atresia; transpalatine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96146","name":"Psycl/nrpsyc tst auto result","description":"Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64734","name":"Incision of cheek nerve","description":"Transection or avulsion of; infraorbital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":445.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84275","name":"Assay of sialic acid","description":"Sialic acid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81015","name":"Microscopic exam of urine","description":"Urinalysis; microscopic only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4532","name":"Ped size pull-on lg","description":"Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01130","name":"Anes body cast appl/revj","description":"Anesthesia for body cast application or revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67208","name":"Treatment of retinal lesion","description":"Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; cryotherapy, diathermy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":361.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2373","name":"Hand/chin ctrl spec joystick","description":"Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR","","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74190","name":"Peritoneogram rs&i","description":"Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8047","name":"Nasal septal prosthesis","description":"Nasal septal prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":752.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28605","name":"Treat foot dislocation","description":"Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77789","name":"Apply surf ldr radionuclide","description":"Surface application of low dose rate radionuclide source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0020","name":"Fixed adjust armrest pair","description":"Fixed, adjustable height armrest, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00190","name":"Anes px facial b1/skull nos","description":"Anesthesia for procedures on facial bones or skull; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01472","name":"Anes rpr rpt achilles tendon","description":"Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; repair of ruptured achilles tendon, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2240","name":"Round caliper and plate atta","description":"Addition to lower extremity, round caliper and plate attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25425","name":"Repair/graft radius or ulna","description":"Repair of defect with autograft; radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":815.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01951","name":"Anes 2&3 burn less 4 % tbsa","description":"Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (tbsa) treated during anesthesia and surgery; less than 4% total body surface area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75807","name":"Lymph vessel x-ray trunk","description":"Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62194","name":"Replace/irrigate catheter","description":"Replacement or irrigation, subarachnoid/subdural catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30801","name":"Ablate inf turbinate superf","description":"Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":162.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31201","name":"Removal of ethmoid sinus","description":"Ethmoidectomy; intranasal, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99233","name":"Sbsq hosp ip/obs high 50","description":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 50 minutes m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0442","name":"Stationary o2 contents, liq","description":"Stationary oxygen contents, liquid, 1 months supply = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89321","name":"Semen anal sperm detection","description":"Semen analysis; sperm presence and motility of sperm, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20822","name":"Replantation digit complete","description":"Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1503.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25100","name":"Biopsy of wrist joint","description":"Arthrotomy, wrist joint; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8623","name":"Lith ion batt cid,non-earlvl","description":"Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19369","name":"Brst rcnstj 2 pdcl tram flap","description":"Breast reconstruction; with bipedicled transverse rectus abdominis myocutaneous (tram) flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1317.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54830","name":"Remove epididymis lesion","description":"Excision of local lesion of epididymis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80158","name":"Drug assay cyclosporine","description":"Cyclosporine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36010","name":"Place catheter in vein","description":"Introduction of catheter, superior or inferior vena cava","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82013","name":"Acetylcholinesterase assay","description":"Acetylcholinesterase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01832","name":"Anes arthr/ndsc tot wrst rpl","description":"Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; total wrist replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87015","name":"Specimen infect agnt concntj","description":"Concentration (any type), for infectious agents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83605","name":"Assay of lactic acid","description":"Lactate (lactic acid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7012","name":"Nebulizer water collec devic","description":"Water collection device, used with large volume nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44300","name":"Open bowel to skin","description":"Placement, enterostomy or cecostomy, tube open (eg, for feeding or decompression) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28735","name":"Fusion of foot bones","description":"Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (eg, flatfoot correction)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":636.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6443","name":"Conform band n/s w>=3in<5in/yd","description":"Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45500","name":"Repair of rectum","description":"Proctoplasty; for stenosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":466.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33518","name":"Cabg artery-vein two","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":359.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93296","name":"Rem interrog evl pm/ids","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31241","name":"Nsl/sns ndsc lig sphnptn art","description":"Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67334","name":"Revise eye muscle w/suture","description":"Strabismus surgery by posterior fixation suture technique, with or without muscle recession (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73223","name":"Mri joint upr extr w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21347","name":"Opn tx nasomax fx multple","description":"Open treatment of nasomaxillary complex fracture (lefort ii type); requiring multiple open approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":826.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31805","name":"Repair of windpipe injury","description":"Suture of tracheal wound or injury; intrathoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27086","name":"Remove hip foreign body","description":"Removal of foreign body, pelvis or hip; subcutaneous tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62223","name":"Establish brain cavity shunt","description":"Creation of shunt; ventriculo-peritoneal, -pleural, other terminus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83951","name":"Oncoprotein dcp","description":"Oncoprotein; des-gamma-carboxy-prothrombin (dcp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8613","name":"Ossicular implant","description":"Ossicula implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32215","name":"Treat chest lining","description":"Pleural scarification for repeat pneumothorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99307","name":"Sbsq nf care sf mdm 10","description":"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 10 minutes must be met or e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84182","name":"Protein western blot test","description":"Protein; western blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78267","name":"Urea breath tst c-14 acquisj","description":"Urea breath test, c-14 (isotopic); acquisition for analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36838","name":"Dist revas ligation hemo","description":"Distal revascularization and interval ligation (dril), upper extremity hemodialysis access (steal syndrome)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1008.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2390","name":"Offset knee joint each","description":"Addition to lower extremity, offset knee joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91038","name":"Esoph imped funct test > 1hr","description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to 24 hours)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0207T","name":"Clear eyelid gland w/heat","description":"Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27060","name":"Removal of ischial bursa","description":"Excision; ischial bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67935","name":"Repair eyelid wound","description":"Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; full thickness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45346","name":"Sigmoidoscopy w/ablation","description":"Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2123.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78709","name":"K flow/funct image multiple","description":"Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99386","name":"Prev visit new age 40-64","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0453","name":"Cont intraop neuro monitor","description":"Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95922","name":"Autonomic nrv adrenrg inervj","description":"Testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and r-r interval changes during valsalva maneuver and at least 5 minutes of passive tilt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50130","name":"Pyelotomy w/removal calculus","description":"Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80184","name":"Assay of phenobarbital","description":"Phenobarbital","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93283","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantab","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36581","name":"Replace tunneled cv cath","description":"Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2180","name":"Plas shoe insert w ank joint","description":"Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42820","name":"Remove tonsils and adenoids","description":"Tonsillectomy and adenoidectomy; younger than age 12","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58976","name":"Transfer of embryo","description":"Gamete, zygote, or embryo intrafallopian transfer, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96155","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83586","name":"Assay 17- ketosteroids","description":"Ketosteroids, 17- (17-ks); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87560","name":"M.avium-intra dna dir prob","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria avium-intracellulare, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0560T","name":"Antmc mdl 3d print ea addl","description":"Anatomic model 3d-printed from image data set(s); each additional individually prepared and processed component of an anatomic structure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0578T","name":"Rem interrog dev icds phys","description":"Interrogation device evaluation(s) (remote), up to 90 days, substernal lead implantable cardioverter-defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0431","name":"Portable gaseous 02","description":"Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81184","name":"Cacna1a gen detc abnor allel","description":"Cacna1a (calcium voltage-gated channel subunit alpha1 a) (eg, spinocerebellar ataxia) gene analysis; evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27125","name":"Partial hip replacement","description":"Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":958.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4605","name":"Trach suction cath close sys","description":"Tracheal suction catheter, closed system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93545","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43283","name":"Lap esoph lengthening","description":"Laparoscopy, surgical, esophageal lengthening procedure (eg, collis gastroplasty or wedge gastroplasty) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20697","name":"App mltpln uni xtrnl fix xch","description":"Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; exchange (ie, removal and replacement) of strut, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1647.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34833","name":"Opn ilac art expos cndt crtj","description":"Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29820","name":"Sho arthrs srg prtl synvct","description":"Arthroscopy, shoulder, surgical; synovectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86078","name":"Phys blood bank serv reactj","description":"Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92977","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27003","name":"Tnot adductr subq opn neurct","description":"Tenotomy, adductor, subcutaneous, open, with obturator neurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":503.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6251","name":"Absorpt drg <=16 sq in w/o b","description":"Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94015","name":"Patient recorded spirometry","description":"Patient-initiated spirometric recording per 30-day period of time; recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4398","name":"Foot drop splint pre ots","description":"Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2005","name":"Post-d/c h vst new pt 75 m","description":"Extensive (75 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0310","name":"Rails bed side full length","description":"Bed side rails, full length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4040","name":"Replace molded thigh lacer","description":"Replace molded thigh lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27049","name":"Resect hip/pelv tum < 5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of pelvis and hip area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1147.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87385","name":"Histoplasma capsul ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; histoplasma capsulatum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25360","name":"Revision of ulna","description":"Osteotomy; ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3257","name":"Orth foot add charge split s","description":"Orthopedic footwear, additional charge for split size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43810","name":"Gastroduodenostomy","description":"Gastroduodenostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99453","name":"Rem mntr physiol param setup","description":"Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); initial set-up and patient education on use of equipment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0484T","name":"Tmvi transthoracic exposure","description":"Transcatheter mitral valve implantation/replacement (tmvi) with prosthetic valve; transthoracic exposure (eg, thoracotomy, transapical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1193.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46288","name":"Repair anal fistula","description":"Closure of anal fistula with rectal advancement flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43030","name":"Cricopharyngeal myotomy","description":"Cricopharyngeal myotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":405.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21557","name":"Resect neck thorax tumor<5cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":808.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69433","name":"Create eardrum opening","description":"Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0749","name":"Elec osteogen stim implanted","description":"Osteogenesis stimulator, electrical, surgically implanted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0197T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70554","name":"Fmri brain by tech","description":"Magnetic resonance imaging, brain, functional mri; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50557","name":"Kidney endoscopy & treatment","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4455","name":"Adhesive remover per ounce","description":"Adhesive remover or solvent (for tape, cement or other adhesive), per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54318","name":"Reconstruction of urethra","description":"Urethroplasty for third stage hypospadias repair to release penis from scrotum (eg, third stage cecil repair)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":575.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3999","name":"Upper limb orthosis nos","description":"Upper limb orthosis, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61630","name":"Balo angioplasty icr perq","description":"Balloon angioplasty, intracranial (eg, atherosclerotic stenosis), percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81172","name":"Aff2 gen alys charac alleles","description":"Aff2 (alf transcription elongation factor 2 [fmr2]) (eg, fragile x intellectual disability 2 [fraxe]) gene analysis; characterization of alleles (eg, expanded size and methylation status)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0523T","name":"Ntrapx c ffr w/3d funcjl map","description":"Intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention (list separately in addition to code ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55530","name":"Revise spermatic cord veins","description":"Excision of varicocele or ligation of spermatic veins for varicocele; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":284.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93886","name":"Intracranial complete study","description":"Transcranial doppler study of the intracranial arteries; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71551","name":"Mri chest w/dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43226","name":"Esoph endoscopy dilation","description":"Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0005","name":"Ultralightweight wheelchair","description":"Ultralightweight wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92522","name":"Evaluate speech production","description":"Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31760","name":"Tracheoplasty intrathoracic","description":"Tracheoplasty; intrathoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68326","name":"Revise/graft eyelid lining","description":"Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2013","name":"Post-d/c h vst ext pt 75 m","description":"Extensive (75 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient fa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53400","name":"Revise urethra stage 1","description":"Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, johannsen type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01772","name":"Anes art upr arm&elbw emblc","description":"Anesthesia for procedures on arteries of upper arm and elbow; embolectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21110","name":"Interdental fixation","description":"Application of interdental fixation device for conditions other than fracture or dislocation, includes removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0070","name":"Rr whl compl pne tire rep ea","description":"Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25355","name":"Revision of radius","description":"Osteotomy, radius; middle or proximal third","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":645.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59614","name":"Vbac care after delivery","description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00210","name":"Anes intracranial px nos","description":"Anesthesia for intracranial procedures; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26518","name":"Fusion of knuckle joints","description":"Capsulodesis, metacarpophalangeal joint; 3 or 4 digits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32557","name":"Insert cath pleura w/ image","description":"Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65760","name":"Keratomileusis","description":"Keratomileusis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":550.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74230","name":"X-ray xm swlng funcj c+","description":"Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86886","name":"Coombs test indirect titer","description":"Antihuman globulin test (coombs test); indirect, each antibody titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25150","name":"Partial removal of ulna","description":"Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":472.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33335","name":"Insert major vessel graft","description":"Insertion of graft, aorta or great vessels; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42550","name":"Injection for salivary x-ray","description":"Injection procedure for sialography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36510","name":"Insertion of catheter vein","description":"Catheterization of umbilical vein for diagnosis or therapy, newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22861","name":"Rev rplcm arthrp 1ntrspc crv","description":"Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86804","name":"Hep c ab test confirm","description":"Hepatitis c antibody; confirmatory test (eg, immunoblot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70130","name":"X-ray exam of mastoids","description":"Radiologic examination, mastoids; complete, minimum of 3 views per side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99421","name":"Ol dig e/m svc 5-10 min","description":"Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G9686","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86147","name":"Cardiolipin antibody ea ig","description":"Cardiolipin (phospholipid) antibody, each ig class","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93315","name":"Echo transesophageal","description":"Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43253","name":"Egd us transmural injxn/mark","description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duoden","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87798","name":"Detect agent nos dna amp","description":"Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; amplified probe technique, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3905","name":"Who w/nontorsion jnt(s) cf","description":"Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01200","name":"Anes all closed px hip joint","description":"Anesthesia for all closed procedures involving hip joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2670","name":"Thorac cont paraspinal uprig","description":"Addition to lower extremity, thoracic control, paraspinal uprights","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32665","name":"Thoracoscop w/esoph musc exc","description":"Thoracoscopy, surgical; with esophagomyotomy (heller type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58820","name":"Drain ovary abscess open","description":"Drainage of ovarian abscess; vaginal approach, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85347","name":"Coagulation time activated","description":"Coagulation time; activated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86780","name":"Treponema pallidum","description":"Antibody; treponema pallidum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61530","name":"Removal of brain lesion","description":"Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; combined with middle/posterior fossa craniotomy/craniectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2844.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22552","name":"Arthrd ant ntrbd cervical ea","description":"Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below c2, each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33933","name":"Prepare donor heart/lung","description":"Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, and trachea for implantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74246","name":"X-ray xm upr gi trc 2cntrst","description":"Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32994","name":"Ablate pulm tumor perq crybl","description":"Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32672","name":"Thoracoscopy for lvrs","description":"Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (lvrs), unilateral includes any pleural procedure, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1218.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78429","name":"Myocrd img pet 1 std w/ct","description":"Myocardial imaging, positron emission tomography (pet), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study; with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72050","name":"X-ray exam neck spine 4/5vws","description":"Radiologic examination, spine, cervical; 4 or 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26844","name":"Fusion/graft of hand joint","description":"Arthrodesis, carpometacarpal joint, digit, other than thumb, each; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3765","name":"Ewhfo rigid w/o jnts cf","description":"Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":567.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84585","name":"Assay of urine vma","description":"Vanillylmandelic acid (vma), urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54318","name":"Reconstruction of urethra","description":"Urethroplasty for third stage hypospadias repair to release penis from scrotum (eg, third stage cecil repair)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37660","name":"Ligation common iliac vein","description":"Ligation of common iliac vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28107","name":"Remove/graft foot lesion","description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95705","name":"Eeg w/o vid 2-12 hr unmntr","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, 2-12 hours; unmonitored","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90863","name":"Pharmacologic mgmt w/psytx","description":"Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00104","name":"Anes electroconvulsive ther","description":"Anesthesia for electroconvulsive therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0501T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43334","name":"Transthor diaphrag hern rpr","description":"Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33615","name":"Repair modified fontan","description":"Repair of complex cardiac anomalies (eg, tricuspid atresia) by closure of atrial septal defect and anastomosis of atria or vena cava to pulmonary artery (simple fontan procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1735.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35656","name":"Bpg femoral-popliteal","description":"Bypass graft, with other than vein; femoral-popliteal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":950.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25295","name":"Release wrist/forearm tendon","description":"Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32654","name":"Thoracoscopy contrl bleeding","description":"Thoracoscopy, surgical; with control of traumatic hemorrhage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93042","name":"Rhythm ecg report","description":"Rhythm ecg, 1-3 leads; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63265","name":"Excise intraspinl lesion crv","description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1512.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5054","name":"Clsd ostomy pouch w/flange","description":"Ostomy pouch, closed; for use on barrier with flange (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70557","name":"Mri brain w/o dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34841","name":"Endovasc visc aorta 1 graft","description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64732","name":"Incision of brow nerve","description":"Transection or avulsion of; supraorbital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65426","name":"Removal of eye lesion","description":"Excision or transposition of pterygium; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":646.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61702","name":"Inner skull vessel surgery","description":"Surgery of simple intracranial aneurysm, intracranial approach; vertebrobasilar circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0549T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25609","name":"Optx dst rd xart fx/ep sep3+","description":"Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0630","name":"Patient lift hydraulic","description":"Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99192","name":"Special pump services","description":"Assembly and operation of pump with oxygenator or heat exchanger (with or without ecg and/or pressure monitoring); 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24150","name":"Rad rescj tum dstl/shft hum","description":"Radical resection of tumor, shaft or distal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0054T","name":"Bone srgry cmptr fluor image","description":"Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2782","name":"Lens, 1.54-1.65 p/1.60-1.79g","description":"Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33025","name":"Incision of heart sac","description":"Creation of pericardial window or partial resection for drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":666.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95819","name":"Eeg awake and asleep","description":"Electroencephalogram (eeg); including recording awake and asleep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1190","name":"Wheelchair amputee w/ leg re","description":"Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88740","name":"Transcutaneous carboxyhb","description":"Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31730","name":"Intro windpipe wire/tube","description":"Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":892.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21360","name":"Opn tx dprsd malar fracture","description":"Open treatment of depressed malar fracture, including zygomatic arch and malar tripod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27282","name":"Arthrodesis symphysis pubis","description":"Arthrodesis, symphysis pubis (including obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":724.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37211","name":"Thrombolytic art therapy","description":"Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8603","name":"Collagen imp urinary 2.5 ml","description":"Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0618","name":"Apnea monitor","description":"Apnea monitor, without recording feature","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9560","name":"Tc99m labeled rbc","description":"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0108","name":"W/c component-accessory nos","description":"Wheelchair component or accessory, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31239","name":"Nsl/sinus endoscopy surg dcr","description":"Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":448.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27295","name":"Amputation of leg at hip","description":"Disarticulation of hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1072.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23474","name":"Revis reconst shoulder joint","description":"Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1480.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q4049","name":"Finger splint, static","description":"Finger splint, static","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15851","name":"Removal sutr/staple req anes","description":"Removal of sutures or staples requiring anesthesia (ie, general anesthesia, moderate sedation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27244","name":"Treat thigh fracture","description":"Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27178","name":"Treat slipped epiphysis","description":"Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":777.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89132","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01392","name":"Anes opn px upr tib fib&/pat","description":"Anesthesia for all open procedures on upper ends of tibia, fibula, and/or patella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88165","name":"Cytopath tbs c/v redo","description":"Cytopathology, slides, cervical or vaginal (the bethesda system); with manual screening and rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32320","name":"Free/remove chest lining","description":"Decortication and parietal pleurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21100","name":"Maxillofacial fixation","description":"Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81050","name":"Urinalysis volume measure","description":"Volume measurement for timed collection, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42962","name":"Control throat bleeding","description":"Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); with secondary surgical intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26450","name":"Incision of palm tendon","description":"Tenotomy, flexor, palm, open, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27506","name":"Treatment of thigh fracture","description":"Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7502","name":"Replacement diaphragm/fplate","description":"Replacement diaphragm/faceplate for tracheostoma valve, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2311","name":"Electro connect btw 2 sys","description":"Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99381","name":"Init pm e/m new pat infant","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age youn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25927","name":"Amputation of hand","description":"Transmetacarpal amputation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":698.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27888","name":"Amputation of foot at ankle","description":"Amputation, ankle, through malleoli of tibia and fibula (eg, syme, pirogoff type procedures), with plastic closure and resection of nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83885","name":"Assay of nickel","description":"Nickel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11624","name":"Exc s/n/h/f/g mal+mrg 3.1-4","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":211.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89321","name":"Semen anal sperm detection","description":"Semen analysis; sperm presence and motility of sperm, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0212T","name":"Compre audiometry evaluation","description":"Comprehensive audiometry threshold evaluation and speech recognition (0209t, 0211t combined), automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85025","name":"Complete cbc w/auto diff wbc","description":"Blood count; complete (cbc), automated (hgb, hct, rbc, wbc and platelet count) and automated differential wbc count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27080","name":"Removal of tail bone","description":"Coccygectomy, primary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23930","name":"I&d upr a/e dp absc/hmtma","description":"Incision and drainage, upper arm or elbow area; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45540","name":"Correct rectal prolapse","description":"Proctopexy (eg, for prolapse); abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":846.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00170","name":"Anes intraoral px nos","description":"Anesthesia for intraoral procedures, including biopsy; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77421","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93596","name":"R&l hrt cath chd nml nt cnj","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); normal native connections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99466","name":"Ped crit care transport","description":"Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; first 30-74 minutes of hands-on care during transport","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26596","name":"Excision constricting tissue","description":"Excision of constricting ring of finger, with multiple z-plasties","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":655.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63042","name":"Laminotomy single lumbar","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44360","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76536","name":"Us exam of head and neck","description":"Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88291","name":"Cyto/molecular report","description":"Cytogenetics and molecular cytogenetics, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4620","name":"Variable concentration mask","description":"Variable concentration mask","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0072","name":"Fr cstr semi-pne tire rep ea","description":"Front caster assembly, complete, with semi-pneumatic tire, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99474","name":"Self-meas bp 2 readg bid 30d","description":"Self-measured blood pressure using a device validated for clinical accuracy; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6217","name":"Non-sterile gauze>16<=48 sq","description":"Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2351","name":"Electronic sgd interface","description":"Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75902","name":"Remove cva lumen obstruct","description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49000","name":"Exploration of abdomen","description":"Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":636.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95967","name":"Meg evoked each addl","description":"Magnetoencephalography (meg), recording and analysis; for evoked magnetic fields, each additional modality (eg, sensory, motor, language, or visual cortex localization) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99222","name":"1st hosp ip/obs moderate 55","description":"Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 55 minutes ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78605","name":"Brain image 4+ views","description":"Brain imaging, minimum 4 static views;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":162.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2109","name":"Spherocylinder 4.25d/4.25-6d","description":"Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65860","name":"Severing ads ant sgm laser","description":"Severing adhesions of anterior segment, laser technique (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":187.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93978","name":"Vascular study","description":"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58346","name":"Insert heyman uteri capsule","description":"Insertion of heyman capsules for clinical brachytherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6629","name":"Lamination collar w/ couplin","description":"Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96020","name":"Functional brain mapping","description":"Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85460","name":"Hemoglobin fetal","description":"Hemoglobin or rbcs, fetal, for fetomaternal hemorrhage; differential lysis (kleihauer-betke)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99475","name":"Ped crit care age 2-5 init","description":"Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":459.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50553","name":"Kidney endoscopy","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":310.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23145","name":"Removal of bone lesion","description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8681","name":"Pt prgrm for implt neurostim","description":"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87903","name":"Phenotype dna hiv w/culture","description":"Infectious agent phenotype analysis by nucleic acid (dna or rna) with drug resistance tissue culture analysis, hiv 1; first through 10 drugs tested","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":271.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95149","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 5 single stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35694","name":"Art trnsposj subclav carotid","description":"Transposition and/or reimplantation; subclavian to carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":871.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53852","name":"Prostatic rf thermotx","description":"Transurethral destruction of prostate tissue; by radiofrequency thermotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1219.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48152","name":"Pancreatectomy","description":"Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (whipple-type procedure); without pancreatojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96151","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93793","name":"Anticoag mgmt pt warfarin","description":"Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (inr) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4185","name":"Pn soln nos 10 grams lipids","description":"Parenteral nutrition solution, not otherwise specified, 10 grams lipids","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0005U","name":"Onco prst8 3 gene ur alg","description":"Oncology (prostate) gene expression profile by real-time rt-pcr of 3 genes (erg, pca3, and spdef), urine, algorithm reported as risk score","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":380.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4055","name":"Replace non-molded calf lace","description":"Replace non-molded calf lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00534","name":"Anes insertion/rplcmt cvdfb","description":"Anesthesia for transvenous insertion or replacement of pacing cardioverter-defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24577","name":"Cltx humrl cndylr fx w/mnpj","description":"Closed treatment of humeral condylar fracture, medial or lateral; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":462.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2265","name":"Long tongue stirrup","description":"Addition to lower extremity, long tongue stirrup","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78803","name":"Rp loclzj tum spect 1 area","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect), single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32096","name":"Open wedge/bx lung infiltr","description":"Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1910","name":"Afo sing bar clasp attach sh","description":"Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83570","name":"Assay of idh enzyme","description":"Isocitric dehydrogenase (idh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95726","name":"Eeg phy/qhp>84 hr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of eeg recording, with video (veeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":272.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49570","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0864","name":"Pwc gp3 xhd mult pow opt s/b","description":"Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92555","name":"Speech threshold audiometry","description":"Speech audiometry threshold;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4635","name":"Underarm crutch pad","description":"Underarm pad, crutch, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8630","name":"Metacarpophalangeal implant","description":"Metacarpophalangeal joint implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99288","name":"Direct advanced life support","description":"Physician or other qualified health care professional direction of emergency medical systems (ems) emergency care, advanced life support","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37619","name":"Ligation of inf vena cava","description":"Ligation of inferior vena cava","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45320","name":"Proctosigmoidoscopy ablate","description":"Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33861","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2469.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11600","name":"Exc tr-ext mal+marg 0.5 cm/<","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35022","name":"Repair artery rupture chest","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, innominate, subclavian artery, by thoracic incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1248.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6019","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":305.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01432","name":"Anes px vn knee&pop av fstl","description":"Anesthesia for procedures on veins of knee and popliteal area; arteriovenous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21355","name":"Perq tx malar fracture","description":"Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65775","name":"Correction of astigmatism","description":"Corneal wedge resection for correction of surgically induced astigmatism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6234","name":"Hydrocolld drg <=16 w/o bdr","description":"Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67908","name":"Repair eyelid defect","description":"Repair of blepharoptosis; conjunctivo-tarso-mullers muscle-levator resection (eg, fasanella-servat type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":312.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32854","name":"Lung transplant with bypass","description":"Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3933","name":"Fo w/o joints cf","description":"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27691","name":"Revise lower leg tendon","description":"Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":617.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29819","name":"Sho arthrs srg rmvl loose/fb","description":"Arthroscopy, shoulder, surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":493.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50722","name":"Release of ureter","description":"Ureterolysis for ovarian vein syndrome","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79440","name":"Nuclear rx intra-articular","description":"Radiopharmaceutical therapy, by intra-articular administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26034","name":"Treat hand bone lesion","description":"Incision, bone cortex, hand or finger (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82310","name":"Assay of calcium","description":"Calcium; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87300","name":"Ag detection polyval if","description":"Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44203","name":"Lap resect s/intestine addl","description":"Laparoscopy, surgical; each additional small intestine resection and anastomosis (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0035","name":"Cardiokymography","description":"Cardiokymography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68841","name":"Insj rx elut implt lac canal","description":"Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0393","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1023.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47605","name":"Cholecystectomy w/cholang","description":"Cholecystectomy; with cholangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":939.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27005","name":"Tenotomy hip flexor open","description":"Tenotomy, hip flexor(s), open (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":608.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00921","name":"Anes px male genitalia vasec","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); vasectomy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99183","name":"Hyperbaric oxygen therapy","description":"Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90956","name":"Esrd srv 1 visit p mo 2-11","description":"End-stage renal disease (esrd) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0115","name":"Post-coital mucous exam","description":"Post-coital direct, qualitative examinations of vaginal or cervical mucous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20808","name":"Replantation hand complete","description":"Replantation, hand (includes hand through metacarpophalangeal joints), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3367.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64585","name":"Rev/rmv perph nstim eltrd ra","description":"Revision or removal of peripheral neurostimulator electrode array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01951","name":"Anes 2&3 burn less 4 % tbsa","description":"Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (tbsa) treated during anesthesia and surgery; less than 4% total body surface area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73560","name":"X-ray exam of knee 1 or 2","description":"Radiologic examination, knee; 1 or 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82248","name":"Bilirubin direct","description":"Bilirubin; direct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26554","name":"Double transfer toe-hand","description":"Transfer, toe-to-hand with microvascular anastomosis; other than great toe, double","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3235.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99203","name":"Office o/p new low 30 min","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49422","name":"Remove tunneled ip cath","description":"Removal of tunneled intraperitoneal catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69930","name":"Implant cochlear device","description":"Cochlear device implantation, with or without mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":987.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36420","name":"Venipuncture cutdown < 1 yr","description":"Venipuncture, cutdown; younger than age 1 year","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3212","name":"Benesch boot pair infant","description":"Benesch boot, pair, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00906","name":"Anes vulvectomy","description":"Anesthesia for; vulvectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33986","name":"Ecmo/ecls rmvl ctr cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84525","name":"Urea nitrogen semi-quant","description":"Urea nitrogen; semiquantitative (eg, reagent strip test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6012","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74713","name":"Mri fetal ea addl gestation","description":"Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5978","name":"Ft prosth multiaxial ankl/ft","description":"All lower extremity prostheses, foot, multiaxial ankle/foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72240","name":"Myelography neck spine","description":"Myelography, cervical, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86352","name":"Cell function assay w/stim","description":"Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, atp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0493","name":"Emr pwr cbl combo vad, rep","description":"Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77058","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":428.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76827","name":"Echo exam of fetal heart","description":"Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47371","name":"Laparo ablate liver cryosurg","description":"Laparoscopy, surgical, ablation of 1 or more liver tumor(s); cryosurgical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1053.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89322","name":"Semen anal strict criteria","description":"Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, kruger)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32151","name":"Remove lung foreign body","description":"Thoracotomy; with removal of intrapulmonary foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":801.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11642","name":"Exc f/e/e/n/l mal+mrg 1.1-2","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75561","name":"Cardiac mri for morph w/dye","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":329.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76080","name":"X-ray exam of fistula","description":"Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3904","name":"Whfo electric custom fitted","description":"Wrist hand finger orthosis, external powered, electric, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1334.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S2083","name":"Adjustment gastric band","description":"Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81272","name":"Kit gene targeted seq analys","description":"Kit (v-kit hardy-zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [gist], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons 8, 11, 13, 17, 18)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":164.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49436","name":"Embedded ip cath exit-site","description":"Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66170","name":"Glaucoma surgery","description":"Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1117.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2425","name":"Knee disc/dial lock/adj flex","description":"Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0220","name":"Thor rib belt custom fabrica","description":"Thoracic, rib belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64836","name":"Repair of hand or foot nerve","description":"Suture of 1 nerve; ulnar motor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":691.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29700","name":"Rmvl/bivlv gauntlet boot/cst","description":"Removal or bivalving; gauntlet, boot or body cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43239","name":"Egd biopsy single/multiple","description":"Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72072","name":"X-ray exam thorac spine 3vws","description":"Radiologic examination, spine; thoracic, 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93299","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":220.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86277","name":"Growth hormone antibody","description":"Growth hormone, human (hgh), antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67909","name":"Revise eyelid defect","description":"Reduction of overcorrection of ptosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01620","name":"Anes clsd px shoulder joint","description":"Anesthesia for all closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29086","name":"Application cast finger","description":"Application, cast; finger (eg, contracture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0738","name":"Portable gas oxygen system","description":"Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45309","name":"Proctosigmoidoscopy removal","description":"Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98942","name":"Chiropractic manj 5 regions","description":"Chiropractic manipulative treatment (cmt); spinal, 5 regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70549","name":"Mr angiograph neck w/o&w/dye","description":"Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63048","name":"Lam facetec &foramot ea addl","description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional vertebral segment, cervical, thoracic, or lumbar (list separately in addition t","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4523","name":"Adult size brief/diaper lg","description":"Adult sized disposable incontinence product, brief/diaper, large, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58350","name":"Reopen fallopian tube","description":"Chromotubation of oviduct, including materials","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27111","name":"Transfer of iliopsoas muscle","description":"Transfer iliopsoas; to femoral neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6025","name":"Silicone gel sheet, each","description":"Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0786","name":"Implantable pump replacement","description":"Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32606","name":"Thoracoscopy w/bx med space","description":"Thoracoscopy, diagnostic (separate procedure); mediastinal space, with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95991","name":"Spin/brain pump refil & main","description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring skill of a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91200","name":"Liver elastography","description":"Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43256","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46211","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33460","name":"Revision of tricuspid valve","description":"Valvectomy, tricuspid valve, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2093.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65435","name":"Curette/treat cornea","description":"Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81187","name":"Cnbp gene detc abnor allele","description":"Cnbp (cchc-type zinc finger nucleic acid binding protein) (eg, myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20700","name":"Mnl prep&insj dp rx dlvr dev","description":"Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51795","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65865","name":"Incise inner eye adhesions","description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); goniosynechiae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00844","name":"Anes iper px abdmnprnl rescj","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; abdominoperineal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33213","name":"Insert pulse gen dual leads","description":"Insertion of pacemaker pulse generator only; with existing dual leads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19306","name":"Mast rad urban type","description":"Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (urban type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26070","name":"Explore/treat hand joint","description":"Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4234","name":"J-cell batt for glucose mon","description":"Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","KL","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27125","name":"Partial hip replacement","description":"Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35686","name":"Bypass graft/av fist patency","description":"Creation of distal arteriovenous fistula during lower extremity bypass surgery (non-hemodialysis) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00540","name":"Anes thoracotomy px nos","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0970","name":"Tlso corset front","description":"Tlso, corset front","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4590","name":"Special casting material","description":"Special casting material (e.g., fiberglass)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25076","name":"Exc forearm tum deep < 3 cm","description":"Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62143","name":"Rpl b1 flp/prostc plate skl","description":"Replacement of bone flap or prosthetic plate of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92587","name":"Evoked auditory test limited","description":"Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95724","name":"Eeg phy/qhp>60<84 hr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 60 hours, up to 84 hours of eeg recording, with video (veeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B5200","name":"Parenteral sol hepatic fream","description":"Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress-branch chain amino acids-freamine-hbc-premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43124","name":"Removal of esophagus","description":"Total or partial esophagectomy, without reconstruction (any approach), with cervical esophagostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3173.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54380","name":"Repair penis","description":"Plastic operation on penis for epispadias distal to external sphincter;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27479","name":"Surgery to stop leg growth","description":"Arrest, epiphyseal, any method (eg, epiphysiodesis); combined distal femur, proximal tibia and fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28636","name":"Treat toe dislocation","description":"Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26546","name":"Repair nonunion hand","description":"Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or internal fixation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":836.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20939","name":"Bone marrow aspir bone grfg","description":"Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88347","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61770","name":"Incise skull for treatment","description":"Stereotactic localization, including burr hole(s), with insertion of catheter(s) or probe(s) for placement of radiation source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1484.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97535","name":"Self care mngment training","description":"Self-care/home management training (eg, activities of daily living (adl) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97163","name":"Pt eval high complex 45 min","description":"Physical therapy evaluation: high complexity, requiring these components: a history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; an examination of body systems using standardized tests and measures addressing a total of 4 or more elements from","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43281","name":"Lap paraesophag hern repair","description":"Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31235","name":"Nsl/sins ndsc dx sphn sinusc","description":"Nasal/sinus endoscopy, diagnostic; with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93242","name":"Ext ecg>48hr<7d recording","description":"External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; recording (includes connection and initial recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81513","name":"Nfct ds bv rna vag flu alg","description":"Infectious disease, bacterial vaginosis, quantitative real-time amplification of rna markers for atopobium vaginae, gardnerella vaginalis, and lactobacillus species, utilizing vaginal-fluid specimens, algorithm reported as a positive or negative result for bacterial vaginosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64560","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77262","name":"Ther radiology tx plng intrm","description":"Therapeutic radiology treatment planning; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01250","name":"Anes all px nrv musc upr leg","description":"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2322","name":"Mult mech switches","description":"Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20660","name":"Apply rem fixation device","description":"Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21558","name":"Resect neck tumor 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00410","name":"Anes integ sys conv arrhyt","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; electrical conversion of arrhythmias","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61618","name":"Repair dura","description":"Secondary repair of dura for cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by free tissue graft (eg, pericranium, fascia, tensor fascia lata, adipose tissue, homologous or synthetic grafts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95120","name":"Immunotherapy one injection","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0250","name":"Md inr test revie inter mgmt","description":"Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of servic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0146","name":"Nav srv peer sup add 30 pr m","description":"Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92065","name":"Orthop traing pfrmd phys/qhp","description":"Orthoptic training; performed by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96168","name":"Hlth bhv ivntj fam ea addl","description":"Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96132","name":"Nrpsyc tst eval phys/qhp 1st","description":"Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the pati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58750","name":"Repair oviduct","description":"Tubotubal anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":583.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28104","name":"Removal of foot lesion","description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49014","name":"Reexploration pelvic wound","description":"Re-exploration of pelvic wound with removal of preperitoneal pelvic packing, including repacking, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26262","name":"Resect distal finger tumor","description":"Radical resection of tumor, distal phalanx of finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36005","name":"Injection ext venography","description":"Injection procedure for extremity venography (including introduction of needle or intracatheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20555","name":"Place ndl musc/tis for rt","description":"Placement of needles or catheters into muscle and/or soft tissue for subsequent interstitial radioelement application (at the time of or subsequent to the procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50060","name":"Nl removal calculus","description":"Nephrolithotomy; removal of calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":922.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31646","name":"Brnchsc w/ther aspir sbsq","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital stay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43195","name":"Esophagoscopy rigid balloon","description":"Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2329","name":"Head control nonproportional","description":"Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39545","name":"Revision of diaphragm","description":"Imbrication of diaphragm for eventration, transthoracic or transabdominal, paralytic or nonparalytic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2613","name":"Position back cush wd <22in","description":"Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15321","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2114","name":"Spherocylinder over 12.00d","description":"Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58550","name":"Laparo-asst vag hysterectomy","description":"Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21433","name":"Optx cranfcl sep comp mlt","description":"Open treatment of craniofacial separation (lefort iii type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61055","name":"Injection into brain canal","description":"Cisternal or lateral cervical (c1-c2) puncture; with injection of medication or other substance for diagnosis or treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54312","name":"Reconstruction of urethra","description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); greater than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67420","name":"Explore/treat eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); with removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74415","name":"Urography nfs drip&/bls w/nf","description":"Urography, infusion, drip technique and/or bolus technique; with nephrotomography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22101","name":"Remove part thorax vertebra","description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":763.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52356","name":"Cysto/uretero w/lithotripsy","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, gibbons or double-j type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4510","name":"Full length surg stocking","description":"Surgical stockings full length, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49428","name":"Ligation of shunt","description":"Ligation of peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":361.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21183","name":"Reconstruct cranial bone","description":"Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 40 sq cm but less than 80 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1950.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99354","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8695","name":"External recharg sys extern","description":"External recharging system for battery (external) for use with implantable neurostimulator, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29820","name":"Sho arthrs srg prtl synvct","description":"Arthroscopy, shoulder, surgical; synovectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":451.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2206","name":"Lens sphcy bifocal 4.00d/ove","description":"Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63655","name":"Implant neuroelectrodes","description":"Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":738.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22848","name":"Insert pelv fixation device","description":"Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":318.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8427","name":"Ready gradient glove","description":"Gradient pressure aid (glove), ready made","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84206","name":"Assay of proinsulin","description":"Proinsulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87336","name":"Entamoeb hist dispr ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; entamoeba histolytica dispar group","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2388","name":"Foam drive wheel tire","description":"Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25695","name":"Optx lunate dislocation","description":"Open treatment of lunate dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":535.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57023","name":"I&d vaginal hematoma non-ob","description":"Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma, spontaneous bleeding)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0945","name":"Belt/harness extremity","description":"Extremity belt/harness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50620","name":"Removal of ureter stone","description":"Ureterolithotomy; middle one-third of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15774","name":"Gfrg autol fat lipo ea addl","description":"Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35512","name":"Art byp grft subclav-brchial","description":"Bypass graft, with vein; subclavian-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6960","name":"Shldr disartic switch contro","description":"Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27762","name":"Cltx med ankle fx w/mnpj","description":"Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":399.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S0610","name":"Annual gynecological examina","description":"Annual gynecological examination, new patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74710","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86294","name":"Immunoassay tumor qual","description":"Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73530","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69660","name":"Revise middle ear bone","description":"Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":747.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5974","name":"Foot single axis ankle/foot","description":"All lower extremity prostheses, foot, single axis ankle/foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54352","name":"Revj prior hypspad repair","description":"Revision of prior hypospadias repair requiring extensive dissection and excision of previously constructed structures including re-release of chordee and reconstruction of urethra and penis by use of local skin as grafts and island flaps and skin brought in as flaps or grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1146.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26250","name":"Extensive hand surgery","description":"Radical resection of tumor, metacarpal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":902.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5501","name":"Diabetic custom molded shoe","description":"For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patients foot (custom molded shoe), per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3702","name":"Eo w/o joints cf","description":"Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70360","name":"X-ray exam of neck","description":"Radiologic examination; neck, soft tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76936","name":"Echo guide for artery repair","description":"Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11012","name":"Deb skin bone at fx site","description":"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0276","name":"Bed pan fracture","description":"Bed pan, fracture, metal or plastic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68362","name":"Revise eyelid lining","description":"Conjunctival flap; total (such as gunderson thin flap or purse string flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43335","name":"Transthor diaphrag hern rpr","description":"Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99407","name":"Behav chng smoking > 10 min","description":"Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2810","name":"Knee control condylar pad","description":"Addition to lower extremity orthosis, knee control, condylar pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34111","name":"Removal of arm artery clot","description":"Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6380","name":"Postop dsg cast chg wrst/elb","description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":687.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92547","name":"Supplemental electrical test","description":"Use of vertical electrodes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8512","name":"Gel cap for trach voice pros","description":"Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38794","name":"Access thoracic lymph duct","description":"Cannulation, thoracic duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92228","name":"Img rta detc/mntr ds phy/qhp","description":"Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1680","name":"Pelvic & hip control thigh c","description":"Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33020","name":"Incision of heart sac","description":"Pericardiotomy for removal of clot or foreign body (primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":715.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92310","name":"Contact lens fitting ou","description":"Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77048","name":"Mri breast c-+ w/cad uni","description":"Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (cad real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":306.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98977","name":"Rtm dev sply mscskl 16-30 d","description":"Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 16-30 days in a 30-day period","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0372","name":"Powered air mattress overlay","description":"Powered air overlay for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44021","name":"Decompress small bowel","description":"Enterotomy, small intestine, other than duodenum; for decompression (eg, baker tube)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":809.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86628","name":"Candida antibody","description":"Antibody; candida","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93282","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5617","name":"Ak/bk self-aligning unit ea","description":"Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78480","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64834","name":"Repair of hand or foot nerve","description":"Suture of 1 nerve; hand or foot, common sensory nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10022","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52402","name":"Cysto trurl rescj ejacul dux","description":"Cystourethroscopy with transurethral resection or incision of ejaculatory ducts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86664","name":"Epstein-barr nuclear antigen","description":"Antibody; epstein-barr (eb) virus, nuclear antigen (ebna)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59820","name":"Care of miscarriage","description":"Treatment of missed abortion, completed surgically; first trimester","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27487","name":"Revise/replace knee joint","description":"Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0640","name":"Lso s/c shell/panel custom","description":"Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by ove","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":509.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4301","name":"Implantable access syst perc","description":"Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83615","name":"Lactate (ld) (ldh) enzyme","description":"Lactate dehydrogenase (ld), (ldh);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78290","name":"Intestine imaging","description":"Intestine imaging (eg, ectopic gastric mucosa, meckels localization, volvulus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25449","name":"Revj arthrp wrist joint","description":"Revision of arthroplasty, including removal of implant, wrist joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":868.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3230","name":"Custom shoes depth inlay","description":"Orthopedic footwear, custom shoe, depth inlay, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11451","name":"Exc skn hdrdnt ax complex","description":"Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99461","name":"Init nb em per day non-fac","description":"Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84681","name":"Assay of c-peptide","description":"C-peptide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58353","name":"Endometr ablate thermal","description":"Endometrial ablation, thermal, without hysteroscopic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":625.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0472T","name":"Prgrmg io rta eltrd ra","description":"Device evaluation, interrogation, and initial programming of intraocular retinal electrode array (eg, retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with r","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3430","name":"Sho heel count plast reinfor","description":"Heel, counter, plastic reinforced","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8618","name":"Coch implant tran cable repl","description":"Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93539","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28202","name":"Repair/graft of foot tendon","description":"Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":487.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86603","name":"Adenovirus antibody","description":"Antibody; adenovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58120","name":"Dilation and curettage","description":"Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78660","name":"Nuclear exam of tear flow","description":"Radiopharmaceutical dacryocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27441","name":"Revision of knee joint","description":"Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":696.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48547","name":"Duodenal exclusion","description":"Duodenal exclusion with gastrojejunostomy for pancreatic injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5513","name":"Multi den insert custom mold","description":"For diabetics only, multiple density insert, custom molded from model of patients foot, total contact with patients foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6640","name":"Shoulder abduction joint pai","description":"Upper extremity additions, shoulder abduction joint, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0815","name":"Pwc gp 1 std seat/back","description":"Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35142","name":"Repair artery rupture thigh","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, common femoral artery (profunda femoris, superficial femoral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1169.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23455","name":"Repair shoulder capsule","description":"Capsulorrhaphy, anterior; with labral repair (eg, bankart procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33987","name":"Artery expos/graft artery","description":"Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ecmo/ecls (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2000","name":"Kafo sing fre stirr thi/calf","description":"Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar ak orthosis), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5430","name":"Postop dsg ak ea add cast ch","description":"Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, ak or knee disarticulation, each additional cast change and realignment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82950","name":"Glucose test","description":"Glucose; post glucose dose (includes glucose)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5710","name":"Kne-shin exo sng axi mnl loc","description":"Addition, exoskeletal knee-shin system, single axis, manual lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21194","name":"Reconst lwr jaw w/graft","description":"Reconstruction of mandibular rami, horizontal, vertical, c, or l osteotomy; with bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11770","name":"Exc pilonidal cyst simple","description":"Excision of pilonidal cyst or sinus; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4253","name":"Blood glucose/reagent strips","description":"Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","KL","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5978","name":"Ft prosth multiaxial ankl/ft","description":"All lower extremity prostheses, foot, multiaxial ankle/foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00192","name":"Anes px fcl b1/skl rad surg","description":"Anesthesia for procedures on facial bones or skull; radical surgery (including prognathism)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41830","name":"Removal of gum tissue","description":"Alveolectomy, including curettage of osteitis or sequestrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82397","name":"Chemiluminescent assay","description":"Chemiluminescent assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92242","name":"Fluorescein&icg angiography","description":"Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0140","name":"Nav srv peer sup 60 min pr m","description":"Principal illness navigation - peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities:  person-centered interview, performed to better underst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90959","name":"Esrd serv 1 vst p mo 12-19","description":"End-stage renal disease (esrd) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per mont","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77077","name":"Joint survey single view","description":"Joint survey, single view, 2 or more joints (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22526","name":"Idet single level","description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44369","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33363","name":"Replace aortic valve open","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open axillary artery approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63664","name":"Revise spine eltrd plate","description":"Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":780.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"S3835","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31540","name":"Laryngoscopy w/exc of tumor","description":"Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99448","name":"Ntrprof ph1/ntrnet/ehr 21-30","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patients treating/requesting physician or other qualified health care profess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83661","name":"L/s ratio fetal lung","description":"Fetal lung maturity assessment; lecithin sphingomyelin (l/s) ratio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50705","name":"Ureteral embolization/occl","description":"Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1534.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84410","name":"Testosterone bioavailable","description":"Testosterone; bioavailable, direct measurement (eg, differential precipitation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85230","name":"Clot factor vii proconvertin","description":"Clotting; factor vii (proconvertin, stable factor)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61570","name":"Remove foreign body brain","description":"Craniectomy or craniotomy; with excision of foreign body from brain","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35231","name":"Repair blvsl vn grf neck","description":"Repair blood vessel with vein graft; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85400","name":"Fibrinolytic plasmin","description":"Fibrinolytic factors and inhibitors; plasmin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0509T","name":"Pattern erg w/i&r","description":"Electroretinography (erg) with interpretation and report, pattern (perg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38308","name":"Incision of lymph channels","description":"Lymphangiotomy or other operations on lymphatic channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82948","name":"Reagent strip/blood glucose","description":"Glucose; blood, reagent strip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5050","name":"Ank symes mold sckt sach ft","description":"Ankle, symes, molded socket, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1214.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88245","name":"Chromosome analysis 20-25","description":"Chromosome analysis for breakage syndromes; baseline sister chromatid exchange (sce), 20-25 cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28675","name":"Repair of toe dislocation","description":"Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30930","name":"Ther fx nasal inf turbinate","description":"Fracture nasal inferior turbinate(s), therapeutic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41826","name":"Excision of gum lesion","description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; with simple repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95726","name":"Eeg phy/qhp>84 hr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of eeg recording, with video (veeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74360","name":"X-ray guide gi dilation","description":"Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5848","name":"Knee-shin sys hydraul stance","description":"Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36563","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device with subcutaneous pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95165","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0108T","name":"Cool quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using cooling stimuli to assess small nerve fiber sensation and hyperalgesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32503","name":"Resect apical lung tumor","description":"Resection of apical lung tumor (eg, pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; without chest wall reconstruction(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0154","name":"Walker platform attachment","description":"Platform attachment, walker, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32669","name":"Thoracoscopy remove segment","description":"Thoracoscopy, surgical; with removal of a single lung segment (segmentectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1075.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8617","name":"Coch implant trans coil repl","description":"Transmitting coil for use with cochlear implant device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A8003","name":"Hard protect helmet custom","description":"Helmet, protective, hard, custom fabricated, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11732","name":"Avlsn nail plate simple each","description":"Avulsion of nail plate, partial or complete, simple; each additional nail plate (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9901","name":"Delivery/set up/dispensing","description":"Dme delivery, set up, and/or dispensing service component of another hcpcs code","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6218","name":"Non-sterile gauze > 48 sq in","description":"Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7030","name":"Cpap full face mask","description":"Full face mask used with positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95852","name":"Range of motion measurements","description":"Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75809","name":"Nonvascular shunt x-ray","description":"Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, leveen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2342","name":"W/c dpth 20-21 in seat frame","description":"Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78072","name":"Parathyrd planar w/spect&ct","description":"Parathyroid planar imaging (including subtraction, when performed); with tomographic (spect), and concurrently acquired computed tomography (ct) for anatomical localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75716","name":"Artery x-rays arms/legs","description":"Angiography, extremity, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64653","name":"Chemodenerv eccrine glands","description":"Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, neck), per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87485","name":"Chlmyd pneum dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia pneumoniae, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9560","name":"Tc99m labeled rbc","description":"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78262","name":"Gastroesophageal reflux std","description":"Gastroesophageal reflux study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73140","name":"X-ray exam of finger(s)","description":"Radiologic examination, finger(s), minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86335","name":"Immunfix e-phorsis/urine/csf","description":"Immunofixation electrophoresis; other fluids with concentration (eg, urine, csf)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4248","name":"Chlorhexidine antisept","description":"Chlorhexidine containing antiseptic, 1 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65781","name":"Ocular reconst transplant","description":"Ocular surface reconstruction; limbal stem cell allograft (eg, cadaveric or living donor)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82045","name":"Albumin ischemia modified","description":"Albumin; ischemia modified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95722","name":"Eeg phy/qhp>36<60 hr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 36 hours, up to 60 hours of eeg recording, with video (veeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70557","name":"Mri brain w/o dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20525","name":"Rmvl fb musc/tdn deep/comp","description":"Removal of foreign body in muscle or tendon sheath; deep or complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50329","name":"Prep renal graft/ureteral","description":"Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; ureteral anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3809","name":"Whfo w/o joints pre ots","description":"Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64470","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59051","name":"Fetal monitor/interpret only","description":"Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; interpretation only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15260","name":"Fth/gft fr n/e/e/l 20 sqcm/<","description":"Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93930","name":"Upper extremity study","description":"Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4616","name":"Tubing (oxygen) per foot","description":"Tubing (oxygen), per foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99304","name":"1st nf care sf/low mdm 25","description":"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. when using total time on the date of the encounter for code selection, 25 minutes mus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31614","name":"Tracheostoma revj complex","description":"Tracheostoma revision; complex, with flap rotation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0999","name":"Add to spinal orthosis nos","description":"Addition to spinal orthosis, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34710","name":"Dlyd plmt xtn prosth 1st vsl","description":"Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":700.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29355","name":"Appl long leg cast walker","description":"Application of long leg cast (thigh to toes); walker or ambulatory type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1945","name":"Afo molded plas rig ant tib","description":"Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":431.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31781","name":"Reconstruct windpipe","description":"Excision tracheal stenosis and anastomosis; cervicothoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1109.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28737","name":"Revision of foot bones","description":"Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicular-cuneiform (eg, miller type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":560.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82585","name":"Assay of cryofibrinogen","description":"Cryofibrinogen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51797","name":"Intraabdominal pressure test","description":"Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28050","name":"Biopsy of foot joint lining","description":"Arthrotomy with biopsy; intertarsal or tarsometatarsal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87084","name":"Culture of specimen by kit","description":"Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26477","name":"Tendon shortening","description":"Shortening of tendon, extensor, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1980","name":"Afo sing solid stirrup calf","description":"Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar bk orthosis), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29880","name":"Arthrs kne srg mnisectmy m&l","description":"Arthroscopy, knee, surgical; with meniscectomy (medial and lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24920","name":"Amputation of upper arm","description":"Amputation, arm through humerus; open, circular (guillotine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":618.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4929","name":"Tourniquet for dialysis, ea","description":"Tourniquet for dialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72147","name":"Mri chest spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1120","name":"Covers for upright each","description":"Addition to ctlso, scoliosis orthosis, cover for upright, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12016","name":"Rpr fe/e/en/l/m 12.6-20.0 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32650","name":"Thoracoscopy w/pleurodesis","description":"Thoracoscopy, surgical; with pleurodesis (eg, mechanical or chemical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":528.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31574","name":"Largsc w/njx augmentation","description":"Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":749.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95133","name":"Immntx 4 sting insects","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 4 stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21315","name":"Clsd tx nsl fx mnpj wo stblj","description":"Closed treatment of nasal bone fracture with manipulation; without stabilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63600","name":"Remove spinal cord lesion","description":"Creation of lesion of spinal cord by stereotactic method, percutaneous, any modality (including stimulation and/or recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80197","name":"Assay of tacrolimus","description":"Tacrolimus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44900","name":"I&d appendix abscess open","description":"Incision and drainage of appendiceal abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00912","name":"Anes trurl px rescj bldr tum","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of bladder tumor(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78190","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":321.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50280","name":"Exc/unroofing cyst kidney","description":"Excision or unroofing of cyst(s) of kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":783.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64835","name":"Repair of hand or foot nerve","description":"Suture of 1 nerve; median motor thenar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":691.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93640","name":"Ep eval 1/2chmbr pacg cvdfb","description":"Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":508.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1260","name":"Anterior thoracic derotation","description":"Addition to tlso, (low profile), anterior thoracic derotation pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85536","name":"Iron stain peripheral blood","description":"Iron stain, peripheral blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58565","name":"Hysteroscopy sterilization","description":"Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1134.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2205","name":"Manual wc accessory, handrim","description":"Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93616","name":"Esophageal recording w/pacg","description":"Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43622","name":"Removal of stomach","description":"Gastrectomy, total; with formation of intestinal pouch, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1946.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77085","name":"Dxa bone density axl vrt fx","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1025","name":"Kyphosis pad floating","description":"Addition to ctlso or scoliosis orthosis, kyphosis pad, floating","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0185","name":"Gel pressure mattress pad","description":"Gel or gel-like pressure pad for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78491","name":"Myocrd img pet 1std rst/strs","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92591","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42650","name":"Dilation of salivary duct","description":"Dilation salivary duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57065","name":"Destruction vag lesion xtnsv","description":"Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12032","name":"Intmd rpr s/a/t/ext 2.6-7.5","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94660","name":"Cpap initiation&mgmt","description":"Continuous positive airway pressure ventilation (cpap), initiation and management","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0982","name":"Stocking sup grips 4 pre ots","description":"Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41110","name":"Excision of tongue lesion","description":"Excision of lesion of tongue without closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88104","name":"Cytopath fl nongyn smears","description":"Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75724","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25078","name":"Resect forarm/wrist tum 3cm>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45990","name":"Surg dx exam anorectal","description":"Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78429","name":"Myocrd img pet 1 std w/ct","description":"Myocardial imaging, positron emission tomography (pet), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study; with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27704","name":"Removal of ankle implant","description":"Removal of ankle implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86360","name":"T cell absolute count/ratio","description":"T cells; absolute cd4 and cd8 count, including ratio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72132","name":"Ct lumbar spine w/dye","description":"Computed tomography, lumbar spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1920","name":"Afo sing upright w/ adjust s","description":"Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78071","name":"Parathyrd planar w/wo subtrj","description":"Parathyroid planar imaging (including subtraction, when performed); with tomographic (spect)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2330","name":"Head control proximity switc","description":"Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82160","name":"Assay of androsterone","description":"Androsterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26434","name":"Repair/graft finger tendon","description":"Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27258","name":"Treat hip dislocation","description":"Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99150","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4542","name":"Small disposable underpad","description":"Incontinence product, disposable underpad, small size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28360","name":"Reconstruct cleft foot","description":"Reconstruction, cleft foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":922.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57135","name":"Excision vaginal cyst/tumor","description":"Excision of vaginal cyst or tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20979","name":"Lw ntsty us stimj bone healg","description":"Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67903","name":"Repair eyelid defect","description":"Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86747","name":"Parvovirus antibody","description":"Antibody; parvovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00836","name":"Anes hrna rpr<37wk brth<50","description":"Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants younger than 37 weeks gestational age at birth and younger than 50 weeks gestational age at time of surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29700","name":"Rmvl/bivlv gauntlet boot/cst","description":"Removal or bivalving; gauntlet, boot or body cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20220","name":"Bone biopsy trocar/ndl supfc","description":"Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35556","name":"Art byp grft fem-popliteal","description":"Bypass graft, with vein; femoral-popliteal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33619","name":"Repair single ventricle","description":"Repair of single ventricle with aortic outflow obstruction and aortic arch hypoplasia (hypoplastic left heart syndrome) (eg, norwood procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2380.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44680","name":"Surgical revision intestine","description":"Intestinal plication (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19316","name":"Mastopexy","description":"Mastopexy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":501.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95807","name":"Sleep study attended","description":"Sleep study, simultaneous recording of ventilation, respiratory effort, ecg or heart rate, and oxygen saturation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67966","name":"Revision of eyelid","description":"Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99214","name":"Office o/p est mod 30 min","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28475","name":"Cltx metatarsal fx w/mnpj ea","description":"Closed treatment of metatarsal fracture; with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4394","name":"Replace foot drop spint","description":"Replace soft interface material, foot drop splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87797","name":"Detect agent nos dna dir","description":"Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; direct probe technique, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67450","name":"Explore/biopsy eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); for exploration, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77787","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":607.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1002","name":"Pwr seat tilt","description":"Wheelchair accessory, power seating system, tilt only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63270","name":"Excise intrspinl lesion crvl","description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1903.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11303","name":"Shave skin lesion >2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31541","name":"Larynscop w/tumr exc + scope","description":"Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41016","name":"Drainage of mouth lesion","description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submental","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88285","name":"Chromosome count additional","description":"Chromosome analysis; additional cells counted, each study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82085","name":"Assay of aldolase","description":"Aldolase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88267","name":"Chromosome analys placenta","description":"Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, 1 karyotype, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44316","name":"Devise bowel pouch","description":"Continent ileostomy (kock procedure) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94452","name":"Hast w/i&r phys/qhp","description":"High altitude simulation test (hast), with interpretation and report by a physician or other qualified health care professional;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49561","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":776.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46600","name":"Diagnostic anoscopy spx","description":"Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81184","name":"Cacna1a gen detc abnor allel","description":"Cacna1a (calcium voltage-gated channel subunit alpha1 a) (eg, spinocerebellar ataxia) gene analysis; evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2365","name":"U1 sealed leadacid battery","description":"Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20670","name":"Removal implant superficial","description":"Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27235","name":"Treat thigh fracture","description":"Percutaneous skeletal fixation of femoral fracture, proximal end, neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":767.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L7274","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3115.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2214","name":"Pneumatic caster tire each","description":"Manual wheelchair accessory, pneumatic caster tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1971","name":"Afo w/ankle joint, prefab","description":"Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0077","name":"Fr cstr asmb sol tire rep ea","description":"Front caster assembly, complete, with solid tire, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41000","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5504","name":"Diabetic shoe with wedge","description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3710","name":"Eo elas w/metal jnts pre ots","description":"Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85379","name":"Fibrin degradation quant","description":"Fibrin degradation products, d-dimer; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85170","name":"Blood clot retraction","description":"Clot retraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4010","name":"Replace trilateral socket br","description":"Replace trilateral socket brim","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82180","name":"Assay of ascorbic acid","description":"Ascorbic acid (vitamin c), blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82523","name":"Collagen crosslinks","description":"Collagen cross links, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67835","name":"Revise eyelashes","description":"Correction of trichiasis; incision of lid margin, with free mucous membrane graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28665","name":"Treat toe dislocation","description":"Closed treatment of interphalangeal joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78465","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":428.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62380","name":"Ndsc dcmprn 1 ntrspc lumbar","description":"Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1286.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4217","name":"Sterile water/saline, 500 ml","description":"Sterile water/saline, 500 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","AU","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86812","name":"Hla typing a b or c","description":"Hla typing; a, b, or c (eg, a10, b7, b27), single antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4385","name":"Ost skn barrier sld ext wear","description":"Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86805","name":"Lymphocytotoxicity assay","description":"Lymphocytotoxicity assay, visual crossmatch; with titration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25415","name":"Repair radius & ulna","description":"Repair of nonunion or malunion, radius and ulna; without graft (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":819.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26215","name":"Remove/graft finger lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96934","name":"Rcm img acquisj&i&r ea addl","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54840","name":"Remove epididymis lesion","description":"Excision of spermatocele, with or without epididymectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":260.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95875","name":"Limb exercise test","description":"Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88272","name":"Cytogenetics 3-5","description":"Molecular cytogenetics; chromosomal in situ hybridization, analyze 3-5 cells (eg, for derivatives and markers)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1769","name":"Guide wire","description":"Guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80178","name":"Assay of lithium","description":"Lithium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58544","name":"Lsh w/t/o uterus above 250 g","description":"Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":579.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29879","name":"Arthrs kne srg abrasj arthrp","description":"Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77071","name":"Mnl appl strs jt radiography","description":"Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63266","name":"Excise intrspinl lesion thrc","description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95801","name":"Slp stdy unatnd w/anal","description":"Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86485","name":"Skin test candida","description":"Skin test; candida","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74363","name":"X-ray bile duct dilation","description":"Percutaneous transhepatic dilation of biliary duct stricture with or without placement of stent, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8511","name":"Indwelling trach insert","description":"Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0505T","name":"Ev fempop artl revsc","description":"Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0443","name":"Portable 02 contents, gas","description":"Portable oxygen contents, gaseous, 1 months supply = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93623","name":"Prgrmd stimj&pacg iv rx nfs","description":"Programmed stimulation and pacing after intravenous drug infusion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35506","name":"Art byp grft subclav-carotid","description":"Bypass graft, with vein; carotid-subclavian or subclavian-carotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63746","name":"Removal of spinal shunt","description":"Removal of entire lumbosubarachnoid shunt system without replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":543.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28232","name":"Incision of toe tendon","description":"Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":311.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27120","name":"Reconstruction of hip socket","description":"Acetabuloplasty; (eg, whitman, colonna, haygroves, or cup type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2200","name":"Limited ankle motion ea jnt","description":"Addition to lower extremity, limited ankle motion, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0144","name":"Azithromycin dihydrate, oral","description":"Azithromycin dihydrate, oral, capsules/powder, 1 gram","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0481","name":"Microprcsr cu elec vad, rep","description":"Microprocessor control unit for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70559","name":"Mri brain w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":271.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87904","name":"Phenotype dna hiv w/clt add","description":"Infectious agent phenotype analysis by nucleic acid (dna or rna) with drug resistance tissue culture analysis, hiv 1; each additional drug tested (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75731","name":"Artery x-rays adrenal gland","description":"Angiography, adrenal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0250","name":"Hosp bed fixed ht w/ mattres","description":"Hospital bed, fixed height, with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76937","name":"Us guide vascular access","description":"Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (list separately in addition to code for primary ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78601","name":"Brain image w/flow < 4 views","description":"Brain imaging, less than 4 static views; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82760","name":"Assay of galactose","description":"Galactose","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8617","name":"Coch implant trans coil repl","description":"Transmitting coil for use with cochlear implant device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43312","name":"Repair esophagus and fistula","description":"Esophagoplasty (plastic repair or reconstruction), thoracic approach; with repair of tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1324.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87636","name":"Sarscov2 & inf a&b amp prb","description":"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) and influenza virus types a and b, multiplex amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92354","name":"Fitg spect low vis 1system","description":"Fitting of spectacle mounted low vision aid; single element system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1221","name":"Wheelchair spec size w foot","description":"Wheelchair with fixed arm, footrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1893","name":"Intro/sheath, fixed,non-peel","description":"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96523","name":"Irrig drug delivery device","description":"Irrigation of implanted venous access device for drug delivery systems","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44721","name":"Prep donor intestine/artery","description":"Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; arterial anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58720","name":"Removal of ovary/tube(s)","description":"Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":478.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42260","name":"Repair nose to lip fistula","description":"Repair of nasolabial fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56821","name":"Colposcopy vulva w/biopsy","description":"Colposcopy of the vulva; with biopsy(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33927","name":"Impltj tot rplcmt hrt sys","description":"Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44720","name":"Prep donor intestine/venous","description":"Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0276","name":"Pild/placebo control clin tr","description":"Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5790","name":"Exoskeletal ak ultra-light m","description":"Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43634","name":"Removal of stomach partial","description":"Gastrectomy, partial, distal; with formation of intestinal pouch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1788.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63306","name":"Remov vert idrl bdy thrclmbr","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by thoracolumbar approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4034","name":"Enter feed supkit syr by day","description":"Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36475","name":"Endovenous rf 1st vein","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23520","name":"Cltx strnclav dislc w/o mnpj","description":"Closed treatment of sternoclavicular dislocation; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43761","name":"Reposition gastrostomy tube","description":"Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60210","name":"Partial thyroid excision","description":"Partial thyroid lobectomy, unilateral; with or without isthmusectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":597.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24470","name":"Hemiepiphyseal arrest","description":"Hemiepiphyseal arrest (eg, cubitus varus or valgus, distal humerus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29876","name":"Arthrs knee surg synvct maj","description":"Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (eg, medial or lateral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":549.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35508","name":"Art byp grft carotid-vertbrl","description":"Bypass graft, with vein; carotid-vertebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0974","name":"W/ch access anti-rollback","description":"Manual wheelchair accessory, anti-rollback device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01442","name":"Anes px art knee&pop teaec","description":"Anesthesia for procedures on arteries of knee and popliteal area; popliteal thromboendarterectomy, with or without patch graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25442","name":"Arthrp w/prostc dstl ulna","description":"Arthroplasty with prosthetic replacement; distal ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0148","name":"Scr c/v cyto, autosys, rescr","description":"Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69646","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88329","name":"Path consltj drg surg","description":"Pathology consultation during surgery;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35132","name":"Repair artery rupture groin","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, iliac artery (common, hypogastric, external)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97022","name":"Whirlpool therapy","description":"Application of a modality to 1 or more areas; whirlpool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69601","name":"Revj mstdc rsltg compl mstdc","description":"Revision mastoidectomy; resulting in complete mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00474","name":"Anes prtl rib rescj rad px","description":"Anesthesia for partial rib resection; radical procedures (eg, pectus excavatum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49412","name":"Ins device for rt guide open","description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7000","name":"Disposable canister for pump","description":"Canister, disposable, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","KE","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49203","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":978.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0606","name":"Drainage board postural","description":"Postural drainage board","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82710","name":"Fats/lipids feces quant","description":"Fat or lipids, feces; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12052","name":"Intmd rpr face/mm 2.6-5.0 cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72125","name":"Ct neck spine w/o dye","description":"Computed tomography, cervical spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55821","name":"Removal of prostate","description":"Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); suprapubic, subtotal, 1 or 2 stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36558","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":658.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5010","name":"Assessment for hearing aid","description":"Assessment for hearing aid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43458","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99461","name":"Init nb em per day non-fac","description":"Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92522","name":"Evaluate speech production","description":"Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85240","name":"Clot factor viii ahg 1 stage","description":"Clotting; factor viii (ahg), 1-stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7035","name":"Pos airway press headgear","description":"Headgear used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27369","name":"Njx cntrst kne arthg/ct/mri","description":"Injection procedure for contrast knee arthrography or contrast enhanced ct/mri knee arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86590","name":"Streptokinase antibody","description":"Streptokinase, antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP02","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2760","name":"Scratch resistant coating","description":"Scratch resistant coating, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21340","name":"Perq tx nasoethmoid fx","description":"Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including repair of canthal ligaments and/or the nasolacrimal apparatus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38573","name":"Laps pelvic lymphadec","description":"Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4424","name":"Ost pch drain w bar & filter","description":"Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2503","name":"Cntct lens pmma color vision","description":"Contact lens, pmma, color vision deficiency, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88245","name":"Chromosome analysis 20-25","description":"Chromosome analysis for breakage syndromes; baseline sister chromatid exchange (sce), 20-25 cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93017","name":"Cv stress test tracing only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21395","name":"Opn tx orbit periorbt w/grft","description":"Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":850.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61105","name":"Tdh sdrl/ventr pnxr","description":"Twist drill hole for subdural or ventricular puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4000","name":"Repl girdle milwaukee orth","description":"Replace girdle for spinal orthosis (ctlso or so)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55874","name":"Tprnl plmt biodegrdabl matrl","description":"Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6214","name":"Foam drg > 48 sq in w/border","description":"Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27740","name":"Repair of leg epiphyses","description":"Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0373","name":"Nonpowered pressure mattress","description":"Nonpowered advanced pressure reducing mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27630","name":"Removal of tendon lesion","description":"Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65600","name":"Revision of cornea","description":"Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37195","name":"Thrombolytic therapy stroke","description":"Thrombolysis, cerebral, by intravenous infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25076","name":"Exc forearm tum deep < 3 cm","description":"Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":433.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0552T","name":"Low-level laser therapy","description":"Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49325","name":"Lap revision perm ip cath","description":"Laparoscopy, surgical; with revision of previously placed intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35693","name":"Art trnsposj subclavian","description":"Transposition and/or reimplantation; vertebral to subclavian artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":733.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87525","name":"Hepatitis g dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis g, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82775","name":"Assay galactose transferase","description":"Galactose-1-phosphate uridyl transferase; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5722","name":"Knee-shin pneum swg frct exo","description":"Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17106","name":"Dstr cut vsc prlf les<10sqcm","description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33257","name":"Ablate atria lmtd add-on","description":"Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":501.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68330","name":"Revise eyelid lining","description":"Repair of symblepharon; conjunctivoplasty, without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":374.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0102T","name":"Esw phy anes lat hmrl epcndl","description":"Extracorporeal shock wave performed by a physician, requiring anesthesia other than local, and involving the lateral humeral epicondyle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27076","name":"Resect hip tum incl acetabul","description":"Radical resection of tumor; ilium, including acetabulum, both pubic rami, or ischium and acetabulum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88188","name":"Flowcytometry/read 9-15","description":"Flow cytometry, interpretation; 9 to 15 markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2377","name":"Expandable controller, initl","description":"Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92133","name":"Cptrzd oph dx img pst sgm on","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), posterior segment, with interpretation and report, unilateral or bilateral; optic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97162","name":"Pt eval mod complex 30 min","description":"Physical therapy evaluation: moderate complexity, requiring these components: a history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; an examination of body systems using standardized tests and measures in addressing a total of 3 or more elements fro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93268","name":"Ecg record/review","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, review and interpretation by a physician or other qualified hea","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98967","name":"Ph1 assmt&mgmt nqhp 11-20","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5651","name":"Ak flex inner socket ext fra","description":"Addition to lower extremity, above knee, flexible inner socket, external frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97014","name":"Electric stimulation therapy","description":"Application of a modality to 1 or more areas; electrical stimulation (unattended)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2385","name":"Tube, pneumatic caster tire","description":"Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0502","name":"Mobility cart pneum vad, rep","description":"Mobility cart for pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25441","name":"Arthrp w/prostc dstl rds","description":"Arthroplasty with prosthetic replacement; distal radius","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27767","name":"Cltx post ankle fx","description":"Closed treatment of posterior malleolus fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6588","name":"Shdr fair lead cable molded","description":"Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4222","name":"Parenteral supply kit homemi","description":"Parenteral nutrition supply kit; home mix, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2624","name":"Hip adj flex ext abduct cont","description":"Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64910","name":"Nerve repair w/allograft","description":"Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":655.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26350","name":"Repair finger/hand tendon","description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no mans land); primary or secondary without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33875","name":"Thoracic aortic graft","description":"Descending thoracic aorta graft, with or without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54535","name":"Extensive testis surgery","description":"Orchiectomy, radical, for tumor; with abdominal exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68705","name":"Revise tear duct opening","description":"Correction of everted punctum, cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70330","name":"X-ray exam of jaw joints","description":"Radiologic examination, temporomandibular joint, open and closed mouth; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96900","name":"Actinotherapy uv light","description":"Actinotherapy (ultraviolet light)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83885","name":"Assay of nickel","description":"Nickel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35522","name":"Art byp grft axill-brachial","description":"Bypass graft, with vein; axillary-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22862","name":"Rev rplcm rthrp 1ntrspc lmbr","description":"Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2116.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28530","name":"Treat sesamoid bone fracture","description":"Closed treatment of sesamoid fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2397","name":"Pwc acc, lith-based battery","description":"Power wheelchair accessory, lithium-based battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24587","name":"Optx partclr fx&/dslc elbw w","description":"Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius); with implant arthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":920.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2308","name":"Lens sphc trifocal 4.25-7/2.","description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62269","name":"Needle biopsy spinal cord","description":"Biopsy of spinal cord, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0322","name":"Home h physio data collec tr","description":"The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35642","name":"Bpg carotid-vertebral","description":"Bypass graft, with other than vein; carotid-vertebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":868.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83951","name":"Oncoprotein dcp","description":"Oncoprotein; des-gamma-carboxy-prothrombin (dcp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27829","name":"Treat lower leg joint","description":"Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":585.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0517","name":"Remove drug implant","description":"Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78468","name":"Heart infarct image (ef)","description":"Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4928","name":"Surgical mask","description":"Surgical mask, per 20","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9273","name":"Hot/cold botle/cap/col/wrap","description":"Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26116","name":"Exc hand tum deep < 1.5 cm","description":"Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26685","name":"Treat hand dislocation","description":"Open treatment of carpometacarpal dislocation, other than thumb; includes internal fixation, when performed, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78451","name":"Ht muscle image spect sing","description":"Myocardial perfusion imaging, tomographic (spect) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4159","name":"Ef ped complete soy based","description":"Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36592","name":"Collect blood from picc","description":"Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20955","name":"Fibula bone graft microvasc","description":"Bone graft with microvascular anastomosis; fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2031.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90804","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1812","name":"Knee ext/flex w act res ctrl","description":"Dynamic knee, extension/flexion device with active resistance control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85390","name":"Fibrinolysins screen i&r","description":"Fibrinolysins or coagulopathy screen, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84135","name":"Assay of pregnanediol","description":"Pregnanediol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64722","name":"Decompression unspec nerve","description":"Decompression; unspecified nerve(s) (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4354","name":"Cath insertion tray w/bag","description":"Insertion tray with drainage bag but without catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74019","name":"Radex abdomen 2 views","description":"Radiologic examination, abdomen; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11101","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48152","name":"Pancreatectomy","description":"Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (whipple-type procedure); without pancreatojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2430.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6229","name":"Gauze >16<=48 sq in watr/sal","description":"Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26605","name":"Treat metacarpal fracture","description":"Closed treatment of metacarpal fracture, single; with manipulation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61720","name":"Incise skull/brain surgery","description":"Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; globus pallidus or thalamus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98970","name":"Nqhp ol dig assmt&mgmt 5-10","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22224","name":"Osteot dsc ant 1vrt sgm lmbr","description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31578","name":"Largsc w/removal lesion","description":"Laryngoscopy, flexible; with removal of lesion(s), non-laser","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01220","name":"Anes clsd px upper 2/3 femur","description":"Anesthesia for all closed procedures involving upper two-thirds of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70544","name":"Mr angiography head w/o dye","description":"Magnetic resonance angiography, head; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01925","name":"Anes ivntl rad artl crtd/c","description":"Anesthesia for therapeutic interventional radiological procedures involving the arterial system; carotid or coronary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37790","name":"Penile venous occlusion","description":"Penile venous occlusive procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85009","name":"Manual diff wbc count b-coat","description":"Blood count; manual differential wbc count, buffy coat","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15130","name":"Drm agrft t/a/l 1st 100 sqcm","description":"Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33130","name":"Rescj external cardiac tumor","description":"Resection of external cardiac tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93318","name":"Echo transesophageal intraop","description":"Echocardiography, transesophageal (tee) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29893","name":"Endoscopic plantr fasciotomy","description":"Endoscopic plantar fasciotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25685","name":"Optx trns-scphprlnr fx dislc","description":"Open treatment of trans-scaphoperilunar type of fracture dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2112","name":"Afo tibial fracture soft","description":"Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4352","name":"Coude tip urinary catheter","description":"Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47610","name":"Removal of gallbladder","description":"Cholecystectomy with exploration of common duct;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75889","name":"Vein x-ray liver w/hemodynam","description":"Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29355","name":"Appl long leg cast walker","description":"Application of long leg cast (thigh to toes); walker or ambulatory type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0424","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91307","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21215","name":"Lower jaw bone graft","description":"Graft, bone; mandible (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3321.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0011","name":"Stnd wt pwr whlchr w control","description":"Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62326","name":"Njx interlaminar lmbr/sac","description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75840","name":"Vein x-ray adrenal gland","description":"Venography, adrenal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1730","name":"Cath, ep, 19 or few elect","description":"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97139","name":"Unlisted therapeutic px","description":"Unlisted therapeutic procedure (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73718","name":"Mri lower extremity w/o dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69950","name":"Incise inner ear nerve","description":"Vestibular nerve section, transcranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35306","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95052","name":"Photo patch tests","description":"Photo patch test(s) (specify number of tests)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42860","name":"Excision of tonsil tags","description":"Excision of tonsil tags","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43644","name":"Lap gastric bypass/roux-en-y","description":"Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and roux-en-y gastroenterostomy (roux limb 150 cm or less)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1456.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74235","name":"Remove esophagus obstruction","description":"Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26483","name":"Transplant/graft hand tendon","description":"Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free tendon graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81015","name":"Microscopic exam of urine","description":"Urinalysis; microscopic only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90465","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31571","name":"Laryngoscop w/vc inj + scope","description":"Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27769","name":"Optx post ankle fx","description":"Open treatment of posterior malleolus fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55874","name":"Tprnl plmt biodegrdabl matrl","description":"Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2475.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76641","name":"Ultrasound breast complete","description":"Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0289","name":"Arthro, loose body + chondro","description":"Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28540","name":"Treat foot dislocation","description":"Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27110","name":"Transfer of iliopsoas muscle","description":"Transfer iliopsoas; to greater trochanter of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33330","name":"Insert major vessel graft","description":"Insertion of graft, aorta or great vessels; without shunt, or cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1234.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64738","name":"Incision of jaw nerve","description":"Transection or avulsion of; inferior alveolar nerve by osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1900","name":"Afo sprng wir drsflx calf bd","description":"Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33533","name":"Cabg arterial single","description":"Coronary artery bypass, using arterial graft(s); single arterial graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35633","name":"Bpg ilio-mesenteric","description":"Bypass graft, with other than vein; ilio-mesenteric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1752.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97602","name":"Wound(s) care non-selective","description":"Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21931","name":"Exc back les sc 3 cm/>","description":"Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27218","name":"Treat pelvic ring fracture","description":"Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes ipsilateral ilium, sacroiliac joint and/or sacrum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"C1879","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92609","name":"Use of speech device service","description":"Therapeutic services for the use of speech-generating device, including programming and modification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76998","name":"Us guide intraop","description":"Ultrasonic guidance, intraoperative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65235","name":"Remove foreign body from eye","description":"Removal of foreign body, intraocular; from anterior chamber of eye or lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50525","name":"Close nephrovisceral fistula","description":"Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1290.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61516","name":"Crnec treph exc cyst sttl","description":"Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35666","name":"Bpg fem-ant tib pst tib/prnl","description":"Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or peroneal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42300","name":"Drainage of salivary gland","description":"Drainage of abscess; parotid, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66630","name":"Removal of iris","description":"Iridectomy, with corneoscleral or corneal section; sector for glaucoma (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":341.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2213","name":"Pneumatic prop tire insert","description":"Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17311","name":"Mohs 1 stage h/n/hf/g","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), h","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13120","name":"Cmplx rpr s/a/l 1.1-2.5 cm","description":"Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78452","name":"Ht muscle image spect mult","description":"Myocardial perfusion imaging, tomographic (spect) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or red","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15271","name":"Skin sub graft trnk/arm/leg","description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43266","name":"Egd endoscopic stent place","description":"Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":168.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0144","name":"Enclosed walker w rear seat","description":"Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88154","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82232","name":"Assay of beta-2 protein","description":"Beta-2 microglobulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48020","name":"Removal of pancreatic stone","description":"Removal of pancreatic calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":986.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56440","name":"Mrsplzatn brthlns glnd cst","description":"Marsupialization of bartholins gland cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52345","name":"Cysto/uretero w/up stricture","description":"Cystourethroscopy with ureteroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":318.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86171","name":"Complement fixation each","description":"Complement fixation tests, each antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4535","name":"Disposable liner/shield/pad","description":"Disposable liner/shield/guard/pad/undergarment, for incontinence, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49325","name":"Lap revision perm ip cath","description":"Laparoscopy, surgical; with revision of previously placed intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54900","name":"Fusion of spermatic ducts","description":"Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":648.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63088","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26140","name":"Revise finger joint each","description":"Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4525","name":"Adult size pull-on sm","description":"Adult sized disposable incontinence product, protective underwear/pull-on, small size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6920","name":"Wrist disarticul switch ctrl","description":"Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3311.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31785","name":"Remove windpipe lesion","description":"Excision of tracheal tumor or carcinoma; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":808.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64610","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":668.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46750","name":"Repair of anal sphincter","description":"Sphincteroplasty, anal, for incontinence or prolapse; adult","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":594.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20103","name":"Expl pentrg wound extremity","description":"Exploration of penetrating wound (separate procedure); extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99387","name":"Init pm e/m new pat 65+ yrs","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and old","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15825","name":"Rhytdct nck pltysml tghtg","description":"Rhytidectomy; neck with platysmal tightening (platysmal flap, p-flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44110","name":"Excise intestine lesion(s)","description":"Excision of 1 or more lesions of small or large intestine not requiring anastomosis, exteriorization, or fistulization; single enterotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":690.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26508","name":"Release thumb contracture","description":"Release of thenar muscle(s) (eg, thumb contracture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":537.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62322","name":"Njx interlaminar lmbr/sac","description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0117","name":"Glaucoma scrn hgh risk direc","description":"Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39561","name":"Resect diaphragm complex","description":"Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1069.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44650","name":"Repair bowel fistula","description":"Closure of enteroenteric or enterocolic fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1190.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25628","name":"Optx carpl scphd fx int fixj","description":"Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2321","name":"Hand interface joystick","description":"Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR","","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65778","name":"Cover eye w/membrane","description":"Placement of amniotic membrane on the ocular surface; without sutures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":869.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26110","name":"Biopsy finger joint lining","description":"Arthrotomy with biopsy; interphalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22216","name":"Incis addl spine segment","description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57558","name":"D&c of cervical stump","description":"Dilation and curettage of cervical stump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86590","name":"Streptokinase antibody","description":"Streptokinase, antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2105","name":"Spherocylinder 4.00d/4.25-6d","description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0250","name":"Md inr test revie inter mgmt","description":"Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of servic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20206","name":"Biopsy muscle perq needle","description":"Biopsy, muscle, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0431","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23920","name":"Disarticulation shoulder","description":"Disarticulation of shoulder;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":951.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62141","name":"Crnop skull defect>5 cm diam","description":"Cranioplasty for skull defect; larger than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1025.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78216","name":"Lvr&spleen img w/vasc flow","description":"Liver and spleen imaging; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58920","name":"Partial removal of ovary(s)","description":"Wedge resection or bisection of ovary, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17261","name":"Dstrj mal les t/a/l .6-1.0cm","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4332","name":"Lube sterile packet","description":"Lubricant, individual sterile packet, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93591","name":"Perq transcath cls aortic","description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94728","name":"Airwy resist by oscillometry","description":"Airway resistance by oscillometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26442","name":"Release palm & finger tendon","description":"Tenolysis, flexor tendon; palm and finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73630","name":"X-ray exam of foot","description":"Radiologic examination, foot; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61860","name":"Implant neuroelectrodes","description":"Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1430.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84126","name":"Assay of feces porphyrins","description":"Porphyrins, feces, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5639","name":"Below knee wood socket","description":"Addition to lower extremity, below knee, wood socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20969","name":"Bone/skin graft microvasc","description":"Free osteocutaneous flap with microvascular anastomosis; other than iliac crest, metatarsal, or great toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67975","name":"Reconstruction of eyelid","description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92950","name":"Heart/lung resuscitation cpr","description":"Cardiopulmonary resuscitation (eg, in cardiac arrest)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44383","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0343","name":"Laparotomy islet cell transp","description":"Laparotomy for islet cell transplant, includes portal vein catheterization and infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":680.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43247","name":"Egd remove foreign body","description":"Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":285.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24566","name":"Prq skel fix epcndylr hum fx","description":"Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":604.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33513","name":"Cabg vein four","description":"Coronary artery bypass, vein only; 4 coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2157.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93985","name":"Dup-scan hemo compl bi std","description":"Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4651","name":"Calibrated microcap tube","description":"Calibrated microcapillary tube, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89130","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33369","name":"Replace aortic valve w/byp","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86800","name":"Thyroglobulin antibody","description":"Thyroglobulin antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93455","name":"Coronary art/grft angio s&i","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injecti","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80186","name":"Assay of phenytoin free","description":"Phenytoin; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01442","name":"Anes px art knee&pop teaec","description":"Anesthesia for procedures on arteries of knee and popliteal area; popliteal thromboendarterectomy, with or without patch graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93886","name":"Intracranial complete study","description":"Transcranial doppler study of the intracranial arteries; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87181","name":"Sc std agar dilution per agt","description":"Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2213","name":"Lens sphcyl bifo 7.25-12/4.2","description":"Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29710","name":"Rmvl/bivlv sho/hip spica","description":"Removal or bivalving; shoulder or hip spica, minerva, or risser jacket, etc.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82946","name":"Glucagon tolerance test","description":"Glucagon tolerance test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22841","name":"Insert spine fixation device","description":"Internal spinal fixation by wiring of spinous processes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77080","name":"Dxa bone density axial","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86860","name":"Rbc antibody elution","description":"Antibody elution (rbc), each elution","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0337","name":"Hospice evaluation preelecti","description":"Hospice evaluation and counseling services, pre-election","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95721","name":"Eeg phy/qhp>36<60 hr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 36 hours, up to 60 hours of eeg recording, without video","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46275","name":"Remove anal fist inter","description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61322","name":"Crnec/crnot dcmprv w/o lobec","description":"Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82240","name":"Bile acids cholylglycine","description":"Bile acids; cholylglycine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88321","name":"Consltj&reprt sld prep elswr","description":"Consultation and report on referred slides prepared elsewhere","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9612","name":"Catheterize for urine spec","description":"Catheterization for collection of specimen, single patient, all places of service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97110","name":"Therapeutic exercises","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45389","name":"Colonoscopy w/stent plcmt","description":"Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25431","name":"Repair nonunion carpal bone","description":"Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46740","name":"Construction of absent anus","description":"Repair of high imperforate anus with rectourethral or rectovaginal fistula; perineal or sacroperineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42409","name":"Drainage of salivary cyst","description":"Marsupialization of sublingual salivary cyst (ranula)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75827","name":"Vein x-ray chest","description":"Venography, caval, superior, with serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83002","name":"Assay of gonadotropin (lh)","description":"Gonadotropin; luteinizing hormone (lh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15100","name":"Splt agrft t/a/l 1st 100sqcm","description":"Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21615","name":"Excision 1st &/cervical rib","description":"Excision first and/or cervical rib;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":537.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61682","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; supratentorial, complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61618","name":"Repair dura","description":"Secondary repair of dura for cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by free tissue graft (eg, pericranium, fascia, tensor fascia lata, adipose tissue, homologous or synthetic grafts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1131.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95808","name":"Polysom any age 1-3> param","description":"Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5121","name":"Solid skin barrier 6x6","description":"Skin barrier; solid, 6 x 6 or equivalent, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78740","name":"Ureteral reflux study","description":"Ureteral reflux study (radiopharmaceutical voiding cystogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46285","name":"Remove anal fist 2 stage","description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32815","name":"Close bronchial fistula","description":"Open closure of major bronchial fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2241.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12017","name":"Rpr fe/e/en/l/m 20.1-30.0 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86593","name":"Syphilis test non-trep quant","description":"Syphilis test, non-treponemal antibody; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36456","name":"Prtl exchange transfuse nb","description":"Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional, newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29891","name":"Arthr ank ostchn df tal&/tib","description":"Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01320","name":"Anes all px nrv msc kne&/pop","description":"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0318","name":"Prolong home eval add 15m","description":"Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27409","name":"Repair of knee ligaments","description":"Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":818.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43237","name":"Endoscopic us exam esoph","description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4671","name":"Disposable cycler set","description":"Disposable cycler set used with cycler dialysis machine, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99309","name":"Sbsq nf care moderate mdm 30","description":"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3203","name":"Oxford w/ supinator/pronator","description":"Orthopedic shoe, oxford with supinator or pronator, junior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92202","name":"Opscpy extnd on/mac draw","description":"Ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78481","name":"Heart first pass single","description":"Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99424","name":"Prin care mgmt phys 1st 30","description":"Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or de","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6677","name":"Ue triple control harness","description":"Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":144.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0550","name":"Humidif extens supple w ippb","description":"Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85732","name":"Thromboplastin time partial","description":"Thromboplastin time, partial (ptt); substitution, plasma fractions, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69970","name":"Remove inner ear lesion","description":"Removal of tumor, temporal bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L1510","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":746.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0260","name":"Hosp bed semi-electr w/ matt","description":"Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50380","name":"Rnl autotrnsplj rimpltj kdn","description":"Renal autotransplantation, reimplantation of kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23333","name":"Remove shoulder fb deep","description":"Removal of foreign body, shoulder; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7001","name":"Nondisposable pump canister","description":"Canister, non-disposable, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33501","name":"Repair heart vessel fistula","description":"Repair of coronary arteriovenous or arteriocardiac chamber fistula; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":966.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78122","name":"Whl bld volume determination","description":"Whole blood volume determination, including separate measurement of plasma volume and red cell volume (radiopharmaceutical volume-dilution technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6935","name":"Below elbow myoelectronic ct","description":"Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3894.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2328","name":"Head/extremity control inter","description":"Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92355","name":"Fitg spect lw vis cmpnd lens","description":"Fitting of spectacle mounted low vision aid; telescopic or other compound lens system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0307","name":"Cbc without platelet","description":"Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15360","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20200","name":"Muscle biopsy superficial","description":"Biopsy, muscle; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93563","name":"Njx cgen car cth slctv c ang","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50433","name":"Plmt nephroureteral catheter","description":"Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36200","name":"Place catheter in aorta","description":"Introduction of catheter, aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":485.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44206","name":"Lap part colectomy w/stoma","description":"Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (hartmann type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1435.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86408","name":"Neutrlzg antb sarscov2 scr","description":"Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]); screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5826","name":"Miniature knee joint","description":"Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30465","name":"Repair nasal stenosis","description":"Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":749.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33500","name":"Repair heart vessel fistula","description":"Repair of coronary arteriovenous or arteriocardiac chamber fistula; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1354.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28341","name":"Resect enlarged toe","description":"Reconstruction, toe, macrodactyly; requiring bone resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":530.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27238","name":"Treat thigh fracture","description":"Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4414","name":"Ost sknbar w/o conv<=4 sq in","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90960","name":"Esrd srv 4 visits p mo 20+","description":"End-stage renal disease (esrd) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21122","name":"Geniop sldg osteot 2/>","description":"Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":638.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76120","name":"Cine/video x-rays","description":"Cineradiography/videoradiography, except where specifically included","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92265","name":"Ndl oculoelectromyography 1+","description":"Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46220","name":"Excise anal ext tag/papilla","description":"Excision of single external papilla or tag, anus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77404","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6209","name":"Foam drsg <=16 sq in w/o bdr","description":"Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55300","name":"Prepare sperm duct x-ray","description":"Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5728","name":"Knee-shin fluid swg & stance","description":"Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80194","name":"Assay of quinidine","description":"Quinidine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31785","name":"Remove windpipe lesion","description":"Excision of tracheal tumor or carcinoma; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25272","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":469.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8908","name":"Mri w/o fol w/cont, breast,","description":"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4263","name":"Permanent tear duct plug","description":"Permanent, long term, non-dissolvable lacrimal duct implant, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2184","name":"Limited motion knee joint","description":"Addition to lower extremity fracture orthosis, limited motion knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85175","name":"Blood clot lysis time","description":"Clot lysis time, whole blood dilution","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1818","name":"Sps/pass forearm device","description":"Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27187","name":"Reinforce hip bones","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, femoral neck and proximal femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":842.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51600","name":"Injection for bladder x-ray","description":"Injection procedure for cystography or voiding urethrocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57292","name":"Construct vagina with graft","description":"Construction of artificial vagina; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":529.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35022","name":"Repair artery rupture chest","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, innominate, subclavian artery, by thoracic incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01829","name":"Anes dx arthroscopic px wrst","description":"Anesthesia for diagnostic arthroscopic procedures on the wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2100","name":"Bld glucose monitor w voice","description":"Blood glucose monitor with integrated voice synthesizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5840","name":"Multi-axial knee/shin system","description":"Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6708","name":"Term dev mech hand vol open","description":"Terminal device, hand, mechanical, voluntary opening, any material, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78456","name":"Acute venous thrombus image","description":"Acute venous thrombosis imaging, peptide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26100","name":"Biopsy hand joint lining","description":"Arthrotomy with biopsy; carpometacarpal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":283.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62282","name":"Treat spinal canal lesion","description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0420","name":"Ed svc ckd ind per session","description":"Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33866","name":"Aortic hemiarch graft","description":"Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":804.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43246","name":"Egd place gastrostomy tube","description":"Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44208","name":"L colectomy/coloproctostomy","description":"Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1603.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50120","name":"Pyelotomy w/exploration","description":"Pyelotomy; with exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":767.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82615","name":"Test for urine cystines","description":"Cystine and homocystine, urine, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34111","name":"Removal of arm artery clot","description":"Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":526.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52301","name":"Cystoscopy and treatment","description":"Cystourethroscopy; with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48500","name":"Surgery of pancreatic cyst","description":"Marsupialization of pancreatic cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8908","name":"Mri w/o fol w/cont, breast,","description":"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95707","name":"Eeg w/o vid 2-12hr cont mntr","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, 2-12 hours; with continuous, real-time monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54400","name":"Insert semi-rigid prosthesis","description":"Insertion of penile prosthesis; non-inflatable (semi-rigid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46262","name":"Remove in/ex hem grps w/fist","description":"Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":441.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90853","name":"Group psychotherapy","description":"Group psychotherapy (other than of a multiple-family group)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84681","name":"Assay of c-peptide","description":"C-peptide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91010","name":"Esophagus motility study","description":"Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6003","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0802","name":"Pov group 1 vhd 451-600 lbs","description":"Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2207","name":"Crutch and cane holder","description":"Wheelchair accessory, crutch and cane holder, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47140","name":"Partial removal donor liver","description":"Donor hepatectomy (including cold preservation), from living donor; left lateral segment only (segments ii and iii)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2993.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00472","name":"Anes prtl rib rescj thoracop","description":"Anesthesia for partial rib resection; thoracoplasty (any type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25670","name":"Optx rdcrpl/ntrcrpl dislc 1+","description":"Open treatment of radiocarpal or intercarpal dislocation, 1 or more bones","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11404","name":"Exc tr-ext b9+marg 3.1-4 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81007","name":"Urine screen for bacteria","description":"Urinalysis; bacteriuria screen, except by culture or dipstick","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61538","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, with electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2457.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60200","name":"Remove thyroid lesion","description":"Excision of cyst or adenoma of thyroid, or transection of isthmus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82950","name":"Glucose test","description":"Glucose; post glucose dose (includes glucose)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21116","name":"Injection jaw joint x-ray","description":"Injection procedure for temporomandibular joint arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38564","name":"Removal abdomen lymph nodes","description":"Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95803","name":"Actigraphy testing","description":"Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27506","name":"Treatment of thigh fracture","description":"Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1131.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2203","name":"Lens sphcyl bifocal 4.00d/.1","description":"Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0491","name":"Emr pwr source combo vad rep","description":"Emergency power source for use with electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83986","name":"Assay ph body fluid nos","description":"Ph; body fluid, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21925","name":"Biopsy soft tissue of back","description":"Biopsy, soft tissue of back or flank; deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28666","name":"Treat toe dislocation","description":"Percutaneous skeletal fixation of interphalangeal joint dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32035","name":"Thoracostomy w/rib resection","description":"Thoracostomy; with rib resection for empyema","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68530","name":"Clearance of tear duct","description":"Removal of foreign body or dacryolith, lacrimal passages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86759","name":"Rotavirus antibody","description":"Antibody; rotavirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35122","name":"Repair artery rupture belly","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, hepatic, celiac, renal, or mesenteric artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1672.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63621","name":"Srs spinal lesion addl","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77427","name":"Radiation tx management x5","description":"Radiation treatment management, 5 treatments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7366","name":"Battery chrgr 12 volt utah/e","description":"Battery charger, twelve volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74176","name":"Ct abd & pelvis w/o contrast","description":"Computed tomography, abdomen and pelvis; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35152","name":"Repair ruptd popliteal art","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, popliteal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1234.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96368","name":"Ther/diag concurrent inf","description":"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01931","name":"Anes ivnt rad ntrhpt/prt crc","description":"Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intrahepatic or portal circulation (eg, transvenous intrahepatic portosystemic shunt[s] [tips])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92553","name":"Audiometry air & bone","description":"Pure tone audiometry (threshold); air and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31513","name":"Injection into vocal cord","description":"Laryngoscopy, indirect; with vocal cord injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89331","name":"Retrograde ejaculation anal","description":"Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80408","name":"Aldosterone suppression eval","description":"Aldosterone suppression evaluation panel (eg, saline infusion) this panel must include the following: aldosterone (82088 x 2) renin (84244 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75809","name":"Nonvascular shunt x-ray","description":"Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, leveen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61522","name":"Removal of brain abscess","description":"Craniectomy, infratentorial or posterior fossa; for excision of brain abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2006.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1825","name":"Adjust finger ext & flex dev","description":"Dynamic adjustable finger extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86702","name":"Hiv-2 antibody","description":"Antibody; hiv-2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21179","name":"Rcnstj forehead with grafts","description":"Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1281.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00820","name":"Anes px lwr post abdl wall","description":"Anesthesia for procedures on lower posterior abdominal wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0019","name":"Comm hlth intg svs sdoh 60mn","description":"Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50610","name":"Removal of ureter stone","description":"Ureterolithotomy; upper one-third of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76830","name":"Transvaginal us non-ob","description":"Ultrasound, transvaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42310","name":"Drainage of salivary gland","description":"Drainage of abscess; submaxillary or sublingual, intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0978","name":"W/c acc,saf belt pelv strap","description":"Wheelchair accessory, positioning belt/safety belt/pelvic strap, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61544","name":"Remove & treat brain lesion","description":"Craniotomy with elevation of bone flap; for excision or coagulation of choroid plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5810","name":"Endoskel knee-shin mnl lock","description":"Addition, endoskeletal knee-shin system, single axis, manual lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43251","name":"Egd remove lesion snare","description":"Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":366.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38208","name":"Thaw preserved stem cells","description":"Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44389","name":"Colonoscopy with biopsy","description":"Colonoscopy through stoma; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":309.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19301","name":"Partial mastectomy","description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44377","name":"Small bowel endoscopy/biopsy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":229.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99116","name":"Anes comp tot bdy hypthrm","description":"Anesthesia complicated by utilization of total body hypothermia (list separately in addition to code for primary anesthesia procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32674","name":"Thoracoscopy lymph node exc","description":"Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25001","name":"Incise flexor carpi radialis","description":"Incision, flexor tendon sheath, wrist (eg, flexor carpi radialis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":285.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57109","name":"Vagnc bi total pel lymphadec","description":"Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1091.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54324","name":"Reconstruction of urethra","description":"1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":782.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1100","name":"Ring flange plastic/leather","description":"Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92924","name":"Prq trluml c athrc 1 art&/br","description":"Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed, single major coronary artery and/or its branch(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45388","name":"Colonoscopy w/ablation","description":"Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2249.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84375","name":"Chromatogram assay sugars","description":"Sugars, chromatographic, tlc or paper chromatography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21047","name":"Excise lwr jaw cyst w/repair","description":"Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80440","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0563T","name":"Evac meibomian glnd heat bi","description":"Evacuation of meibomian glands, using heat delivered through wearable, open-eye eyelid treatment devices and manual gland expression, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43281","name":"Lap paraesophag hern repair","description":"Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1293.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61611","name":"Transect artery sinus","description":"Transection or ligation, carotid artery in petrous canal; without repair (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34812","name":"Opn fem art expos","description":"Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30520","name":"Repair of nasal septum","description":"Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0625","name":"Lo flex l1-below l5 pre ots","description":"Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0433","name":"Elisa hiv-1/hiv-2 screen","description":"Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99174","name":"Ocular instrumnt screen bil","description":"Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with remote analysis and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38746","name":"Remove thoracic lymph nodes","description":"Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0147","name":"Walker variable wheel resist","description":"Walker, heavy duty, multiple braking system, variable wheel resistance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95044","name":"Patch/application tests","description":"Patch or application test(s) (specify number of tests)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1932","name":"Afo rig ant tib tcf/= custom","description":"Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49650","name":"Lap ing hernia repair init","description":"Laparoscopy, surgical; repair initial inguinal hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64425","name":"Njx aa&/strd ii ih nerves","description":"Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal, iliohypogastric nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35211","name":"Rpr blvsl dir ntrathrc w/byp","description":"Repair blood vessel, direct; intrathoracic, with bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"Q4097","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01920","name":"Anes cardiac catheterization","description":"Anesthesia for cardiac catheterization including coronary angiography and ventriculography (not to include swan-ganz catheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6451","name":"Mod compres band w>=3in<5in/yd","description":"Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71551","name":"Mri chest w/dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0191","name":"Protector heel or elbow","description":"Heel or elbow protector, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33985","name":"Ecmo/ecls rmvl ctr cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17273","name":"Dstr mal les s/n/h/f/g 2.1-3","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70558","name":"Mri brain w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72040","name":"X-ray exam neck spine 2-3 vw","description":"Radiologic examination, spine, cervical; 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4247","name":"Betadine/iodine swabs/wipes","description":"Betadine or iodine swabs/wipes, per box","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75995","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71130","name":"X-ray strenoclavic jt 3/>vws","description":"Radiologic examination; sternoclavicular joint or joints, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78761","name":"Testicular imaging w/flow","description":"Testicular imaging with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20553","name":"Njx 1/mlt trigger points 3/>","description":"Injection(s); single or multiple trigger point(s), 3 or more muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6621","name":"Flex/ext wrist w/wo friction","description":"Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1114.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0156","name":"Walker seat attachment","description":"Seat attachment, walker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2397","name":"Suspension sleeve lower ext","description":"Addition to lower extremity orthosis, suspension sleeve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99241","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0641","name":"Multi-position stnd fram sys","description":"Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":804.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3984","name":"Upper ext fx orthosis wrist","description":"Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":168.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6703","name":"Term dev, passive hand mitt","description":"Terminal device, passive hand/mitt, any material, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90889","name":"Preparation of report","description":"Preparation of report of patients psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20922","name":"Removal of fascia for graft","description":"Fascia lata graft; by incision and area exposure, complex or sheet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":497.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33947","name":"Ecmo/ecls initiation artery","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; initiation, veno-arterial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0560","name":"Humidifier supplemental w/ i","description":"Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80154","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55845","name":"Extensive prostate surgery","description":"Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1104.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50431","name":"Njx px nfrosgrm &/urtrgrm","description":"Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0570","name":"Nebulizer with compression","description":"Nebulizer, with compressor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37236","name":"Open/perq place stent 1st","description":"Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69717","name":"Rplcmt oi implt skl prq esp","description":"Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64859","name":"Nerve surgery","description":"Suture of each additional major peripheral nerve (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0445","name":"High inten beh couns std 30m","description":"High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3973","name":"Sewho airplane w/jnt(s) cf","description":"Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45805","name":"Repair fistula w/colostomy","description":"Closure of rectovesical fistula; with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51990","name":"Laparo urethral suspension","description":"Laparoscopy, surgical; urethral suspension for stress incontinence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":607.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33211","name":"Insert card electrodes dual","description":"Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B9002","name":"Enter nutr inf pump any type","description":"Enteral nutrition infusion pump, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27511","name":"Treatment of thigh fracture","description":"Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":847.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86005","name":"Allg spec ige multiallg scr","description":"Allergen specific ige; qualitative, multiallergen screen (eg, disk, sponge, card)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43229","name":"Esophagoscopy lesion ablate","description":"Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73000","name":"X-ray exam of collar bone","description":"Radiologic examination; clavicle, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5400","name":"Postop dress & 1 cast chg bk","description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23221","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":934.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99464","name":"Attendance at delivery","description":"Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0650","name":"Pneuma compresor non-segment","description":"Pneumatic compressor, non-segmental home model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99462","name":"Sbsq nb em per day hosp","description":"Subsequent hospital care, per day, for evaluation and management of normal newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72100","name":"X-ray exam l-s spine 2/3 vws","description":"Radiologic examination, spine, lumbosacral; 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42809","name":"Remove pharynx foreign body","description":"Removal of foreign body from pharynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37565","name":"Ligation int jugular vein","description":"Ligation, internal jugular vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":615.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27407","name":"Repair of knee ligament","description":"Repair, primary, torn ligament and/or capsule, knee; cruciate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":671.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93620","name":"Comp ep evl r at ven pac&rec","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, his bundle recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8045","name":"Auricular prosthesis","description":"Auricular prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","KM","95","93","NU","","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58953","name":"Tah rad dissect for debulk","description":"Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78268","name":"Urea breath test c-14 alys","description":"Urea breath test, c-14 (isotopic); analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72192","name":"Ct pelvis w/o dye","description":"Computed tomography, pelvis; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43217","name":"Esophagoscopy snare les remv","description":"Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":307.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64410","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85362","name":"Fibrin degradation products","description":"Fibrin(ogen) degradation (split) products (fdp) (fsp); agglutination slide, semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6688","name":"Frame typ sock above elb/dis","description":"Upper extremity addition, frame type socket, above elbow or elbow disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38212","name":"Rbc depletion of harvest","description":"Transplant preparation of hematopoietic progenitor cells; red blood cell removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6960","name":"Shldr disartic switch contro","description":"Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5976.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78001","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92616","name":"Fees w/laryngeal sense test","description":"Flexible endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93882","name":"Extracranial uni/ltd study","description":"Duplex scan of extracranial arteries; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1085","name":"Outrigger bil w/ vert extens","description":"Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20973","name":"Bone/skin graft great toe","description":"Free osteocutaneous flap with microvascular anastomosis; great toe with web space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27396","name":"Transplant of thigh tendon","description":"Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":519.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42650","name":"Dilation of salivary duct","description":"Dilation salivary duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93291","name":"Interrog dev eval scrms ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; subcutaneous cardiac rhythm monitor system, including heart rhythm derived data analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00541","name":"Anes thrcm px 1 lung vntj","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42220","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate; secondary lengthening procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2619","name":"Replace cover w/c seat cush","description":"Replacement cover for wheelchair seat cushion or back cushion, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53445","name":"Insert uro/ves nck sphincter","description":"Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2103","name":"Spherocylindr 4.00d/12-2.00d","description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72285","name":"Discography cerv/thor spine","description":"Discography, cervical or thoracic, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26591","name":"Repair muscles of hand","description":"Repair, intrinsic muscles of hand, each muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":374.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88173","name":"Cytopath eval fna report","description":"Cytopathology, evaluation of fine needle aspirate; interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50957","name":"Ureter endoscopy & treatment","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44137","name":"Remove intestinal allograft","description":"Removal of transplanted intestinal allograft, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":947.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50580","name":"Kidney endoscopy & treatment","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24545","name":"Optx hum fx wo ntrcndylr xtn","description":"Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; without intercondylar extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":784.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22328","name":"Treat each add spine fx","description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43325","name":"Revise esophagus & stomach","description":"Esophagogastric fundoplasty, with fundic patch (thal-nissen procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1139.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81312","name":"Pabpn1 gene detc abnor allel","description":"Pabpn1 (poly[a] binding protein nuclear 1) (eg, oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27130","name":"Total hip arthroplasty","description":"Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64868","name":"Fusion of facial/other nerve","description":"Anastomosis; facial-hypoglossal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":814.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78708","name":"K flow/funct image w/drug","description":"Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26418","name":"Repair finger tendon","description":"Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67966","name":"Revision of eyelid","description":"Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":469.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0115","name":"Post-coital mucous exam","description":"Post-coital direct, qualitative examinations of vaginal or cervical mucous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6714","name":"Ped term dev, hand, vol clos","description":"Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":644.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01680","name":"Anes sho cast appl rmvl/rpr","description":"Anesthesia for shoulder cast application, removal or repair, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6712","name":"Ped term dev, hook, vol clos","description":"Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":603.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92617","name":"Fees w/laryngeal sense i&r","description":"Flexible endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27536","name":"Treat knee fracture","description":"Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1006.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67850","name":"Dstrj lesion lid margin <1cm","description":"Destruction of lesion of lid margin (up to 1 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36819","name":"Av fuse uppr arm basilic","description":"Arteriovenous anastomosis, open; by upper arm basilic vein transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47556","name":"Biliary endoscopy thru skin","description":"Biliary endoscopy, percutaneous via t-tube or other tract; with dilation of biliary duct stricture(s) with stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64822","name":"Sympathectomy ulnar artery","description":"Sympathectomy; ulnar artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99283","name":"Emergency dept visit low mdm","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6632","name":"Latex suspension sleeve each","description":"Upper extremity addition, latex suspension sleeve, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4369","name":"Skin barrier liquid per oz","description":"Ostomy skin barrier, liquid (spray, brush, etc.), per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70450","name":"Ct head/brain w/o dye","description":"Computed tomography, head or brain; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35361","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; combined aortoiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4538","name":"Diaper serv reusable diaper","description":"Diaper service, reusable diaper, each diaper","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43622","name":"Removal of stomach","description":"Gastrectomy, total; with formation of intestinal pouch, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47612","name":"Removal of gallbladder","description":"Cholecystectomy with exploration of common duct; with choledochoenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15826","name":"Rhytidectomy glblr frn lines","description":"Rhytidectomy; glabellar frown lines","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27240","name":"Treat thigh fracture","description":"Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33975","name":"Implant ventricular device","description":"Insertion of ventricular assist device; extracorporeal, single ventricle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1137.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64430","name":"Njx aa&/strd pudendal nerve","description":"Injection(s), anesthetic agent(s) and/or steroid; pudendal nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75790","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35484","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":544.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0444","name":"Portable 02 contents, liquid","description":"Portable oxygen contents, liquid, 1 months supply = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27337","name":"Exc thigh/knee les sc 3 cm/>","description":"Excision, tumor, soft tissue of thigh or knee area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0364","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0121","name":"Colon ca scrn not hi rsk ind","description":"Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","53"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0439T","name":"Myocrd contrast prfuj echo","description":"Myocardial contrast perfusion echocardiography, at rest or with stress, for assessment of myocardial ischemia or viability (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86022","name":"Platelet antibodies","description":"Antibody identification; platelet antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37225","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5639.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43756","name":"Dx duod intub w/asp spec","description":"Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (eg, bile study for crystals or afferent loop culture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0609","name":"Repl electrode for aed","description":"Replacement electrodes for use with automated external defibrillator, garment type only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66820","name":"Incision secondary cataract","description":"Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (ziegler or wheeler knife)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":261.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70488","name":"Ct maxillofacial w/o & w/dye","description":"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24900","name":"Amputation of upper arm","description":"Amputation, arm through humerus; with primary closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86682","name":"Helminth antibody","description":"Antibody; helminth, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14021","name":"Tis trnfr s/a/l 10.1-30 sqcm","description":"Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0608","name":"Repl garment for aed","description":"Replacement garment for use with automated external defibrillator, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0199","name":"Dry pressure pad for mattres","description":"Dry pressure pad for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33496","name":"Repair prosth valve clot","description":"Repair of non-structural prosthetic valve dysfunction with cardiopulmonary bypass (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61548","name":"Removal of pituitary gland","description":"Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1401.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83001","name":"Assay of gonadotropin (fsh)","description":"Gonadotropin; follicle stimulating hormone (fsh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0047","name":"Alcohol/drug abuse svc nos","description":"Alcohol and/or other drug abuse services, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76775","name":"Us exam abdo back wall lim","description":"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28150","name":"Removal of toe","description":"Phalangectomy, toe, each toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":341.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92621","name":"Auditory function + 15 min","description":"Evaluation of central auditory function, with report; each additional 15 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2368","name":"Pwr wc drivewheel motor repl","description":"Power wheelchair component, drive wheel motor, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29868","name":"Meniscal trnspl knee w/scpe","description":"Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38572","name":"Laparoscopy lymphadenectomy","description":"Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0081","name":"Care man h v ext pt 20 mi","description":"Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0279","name":"Tomosynthesis, mammo","description":"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43204","name":"Esoph scope w/sclerosis inj","description":"Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76998","name":"Us guide intraop","description":"Ultrasonic guidance, intraoperative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22226","name":"Osteot dsc ant 1vrt sgm ea","description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64561","name":"Implant neuroelectrodes","description":"Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":605.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27175","name":"Treat slipped epiphysis","description":"Treatment of slipped femoral epiphysis; by traction, without reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0602","name":"Manual breast pump","description":"Breast pump, manual, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7524","name":"Tracheostoma stent/stud/bttn","description":"Tracheostoma stent/stud/button, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0085","name":"Care man h v ext pt 75 m","description":"Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20680","name":"Removal of implant deep","description":"Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0837","name":"Pwc gp 2 hd sing pow opt s/b","description":"Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95060","name":"Oph mucous membrane tests","description":"Ophthalmic mucous membrane tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36400","name":"Vnpnxr<3yrs phy/qhp fem/jug","description":"Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20561","name":"Ndl insj w/o njx 3+ musc","description":"Needle insertion(s) without injection(s); 3 or more muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0443","name":"Portable 02 contents, gas","description":"Portable oxygen contents, gaseous, 1 months supply = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50393","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64868","name":"Fusion of facial/other nerve","description":"Anastomosis; facial-hypoglossal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78481","name":"Heart first pass single","description":"Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36246","name":"Ins cath abd/l-ext art 2nd","description":"Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":706.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21050","name":"Removal of jaw joint","description":"Condylectomy, temporomandibular joint (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86735","name":"Mumps antibody","description":"Antibody; mumps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11952","name":"Subq njx fil matrl 5.1-10cc","description":"Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0981","name":"Seat upholstery, replacement","description":"Wheelchair accessory, seat upholstery, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29440","name":"Adding walker to prev cast","description":"Adding walker to previously applied cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63011","name":"Remove spine lamina 1/2 scrl","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61888","name":"Revise/remove neuroreceiver","description":"Revision or removal of cranial neurostimulator pulse generator or receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":355.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24000","name":"Arthrt elbw expl drg/rmvl fb","description":"Arthrotomy, elbow, including exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86665","name":"Epstein-barr capsid vca","description":"Antibody; epstein-barr (eb) virus, viral capsid (vca)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0947","name":"Fracture frame attachmnts pe","description":"Fracture frame, attachments for complex pelvic traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0121","name":"Colon ca scrn not hi rsk ind","description":"Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22846","name":"Insert spine fixation device","description":"Anterior instrumentation; 4 to 7 vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45540","name":"Correct rectal prolapse","description":"Proctopexy (eg, for prolapse); abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93581","name":"Transcath closure of vsd","description":"Percutaneous transcatheter closure of a congenital ventricular septal defect with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88130","name":"Sex chromatin identification","description":"Sex chromatin identification; barr bodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42870","name":"Excision of lingual tonsil","description":"Excision or destruction lingual tonsil, any method (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64626","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6253","name":"Absorpt drg > 48 sq in w/o b","description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43244","name":"Egd varices ligation","description":"Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1221","name":"Wheelchair spec size w foot","description":"Wheelchair with fixed arm, footrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33964","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0944","name":"Pelvic belt/harness/boot","description":"Pelvic belt/harness/boot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28515","name":"Treatment of toe fracture","description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4561","name":"Pessary reusable rub anytype","description":"Pessary, reusable, rubber, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29885","name":"Arthrs kne srg drlg ost diss","description":"Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":636.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83020","name":"Hemoglobin electrophoresis","description":"Hemoglobin fractionation and quantitation; electrophoresis (eg, a2, s, c, and/or f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2232","name":"Rocker bottom, contact afo","description":"Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6400","name":"Below elbow prosth tiss shap","description":"Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1340.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58951","name":"Resect ovarian malignancy","description":"Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":915.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2511","name":"Cntct toric prism ballast","description":"Contact lens, gas permeable, toric, prism ballast, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01486","name":"Anes open total ankle rplcmt","description":"Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69670","name":"Remove mastoid air cells","description":"Mastoid obliteration (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":764.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76882","name":"Us lmtd jt/fcl evl nvasc xtr","description":"Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24430","name":"Rpr non/mal humerus wo graft","description":"Repair of nonunion or malunion, humerus; without graft (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86146","name":"Beta-2 glycoprotein antibody","description":"Beta 2 glycoprotein i antibody, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60260","name":"Repeat thyroid surgery","description":"Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":916.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29325","name":"Appl hip spica cast1&1/2","description":"Application of hip spica cast; 1 and one-half spica or both legs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4378","name":"Drainable rubber pch w/o fp","description":"Ostomy pouch, drainable, for use on faceplate, rubber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42120","name":"Remove palate/lesion","description":"Resection of palate or extensive resection of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":779.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11055","name":"Paring/cutg b9 hyprker les 1","description":"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50323","name":"Prep cadaver renal allograft","description":"Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64836","name":"Repair of hand or foot nerve","description":"Suture of 1 nerve; ulnar motor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93631","name":"Ntraop epicar&endcar pac&map","description":"Intra-operative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical correction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44143","name":"Partial removal of colon","description":"Colectomy, partial; with end colostomy and closure of distal segment (hartmann type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4525","name":"Adult size pull-on sm","description":"Adult sized disposable incontinence product, protective underwear/pull-on, small size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55865","name":"Extensive prostate surgery","description":"Exposure of prostate, any approach, for insertion of radioactive substance; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"R0075","name":"Transport port x-ray multipl","description":"Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77003","name":"Fluoroguide for spine inject","description":"Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78226","name":"Hepatobiliary system imaging","description":"Hepatobiliary system imaging, including gallbladder when present;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74176","name":"Ct abd & pelvis w/o contrast","description":"Computed tomography, abdomen and pelvis; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33513","name":"Cabg vein four","description":"Coronary artery bypass, vein only; 4 coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00635","name":"Anes dx/ther lumbar pnxr","description":"Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92928","name":"Prq tcat plmt ntrac st 1 les","description":"Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); 1 lesion involving 1 or more coronary segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75842","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26035","name":"Decompress fingers/hand","description":"Decompression fingers and/or hand, injection injury (eg, grease gun)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26556","name":"Toe joint transfer","description":"Transfer, free toe joint, with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78609","name":"Brain imaging (pet)","description":"Brain imaging, positron emission tomography (pet); perfusion evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37250","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44127","name":"Enterectomy w/taper cong","description":"Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; with tapering","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2403.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87810","name":"Chlmyd trach assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; chlamydia trachomatis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51729","name":"Cystometrogram w/vp&up","description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4624","name":"Tracheal suction tube","description":"Tracheal suction catheter, any type other than closed system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45121","name":"Removal of rectum and colon","description":"Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with subtotal or total colectomy, with multiple biopsies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69644","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0310","name":"Immunize counsel 5-15 min","description":"Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28415","name":"Optx calcaneal fracture","description":"Open treatment of calcaneal fracture, includes internal fixation, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":929.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0418","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1289.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92235","name":"Fluorescein angrph mltiframe","description":"Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82953","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0562T","name":"Antmc guide 3d print ea addl","description":"Anatomic guide 3d-printed and designed from image data set(s); each additional anatomic guide (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76948","name":"Echo guide ova aspiration","description":"Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20694","name":"Rmvl ext fixj sys under anes","description":"Removal, under anesthesia, of external fixation system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34203","name":"Removal of leg artery clot","description":"Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":836.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74176","name":"Ct abd & pelvis w/o contrast","description":"Computed tomography, abdomen and pelvis; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48105","name":"Resect/debride pancreas","description":"Resection or debridement of pancreas and peripancreatic tissue for acute necrotizing pancreatitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95933","name":"Blink reflex test","description":"Orbicularis oculi (blink) reflex, by electrodiagnostic testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76641","name":"Ultrasound breast complete","description":"Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98925","name":"Osteopath manj 1-2 regions","description":"Osteopathic manipulative treatment (omt); 1-2 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6641","name":"Excursion amplifier pulley t","description":"Upper extremity addition, excursion amplifier, pulley type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82107","name":"Alpha-fetoprotein l3","description":"Alpha-fetoprotein (afp); afp-l3 fraction isoform and total afp (including ratio)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90963","name":"Esrd home pt serv p mo <2yrs","description":"End-stage renal disease (esrd) related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37253","name":"Intrvasc us noncoronary addl","description":"Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47480","name":"Incision of gallbladder","description":"Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52283","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with steroid injection into stricture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":262.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4305","name":"Drug delivery system >=50 ml","description":"Disposable drug delivery system, flow rate of 50 ml or greater per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87281","name":"Pneumocystis carinii ag if","description":"Infectious agent antigen detection by immunofluorescent technique; pneumocystis carinii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31635","name":"Bronchoscopy w/fb removal","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86384","name":"Nitroblue tetrazolium dye","description":"Nitroblue tetrazolium dye test (ntd)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26011","name":"Drainage of finger abscess","description":"Drainage of finger abscess; complicated (eg, felon)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82247","name":"Bilirubin total","description":"Bilirubin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46083","name":"Inc thrombosed hroid xtrnl","description":"Incision of thrombosed hemorrhoid, external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95955","name":"Eeg during surgery","description":"Electroencephalogram (eeg) during nonintracranial surgery (eg, carotid surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0217","name":"Water circ heat pad w pump","description":"Water circulating heat pad with pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86806","name":"Lymphocytotoxicity assay","description":"Lymphocytotoxicity assay, visual crossmatch; without titration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90964","name":"Esrd home pt serv p mo 2-11","description":"End-stage renal disease (esrd) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27892","name":"Decompression of leg","description":"Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92933","name":"Prq trlml c athrc st angiop1","description":"Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed, single major coronary artery and/or its branch(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77768","name":"Hdr rdncl skn surf brachytx","description":"Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6206","name":"Contact layer <= 16 sq in","description":"Contact layer, sterile, 16 sq. in. or less, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11730","name":"Avulsion nail plate simple 1","description":"Avulsion of nail plate, partial or complete, simple; single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23222","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1268.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4305","name":"Drug delivery system >=50 ml","description":"Disposable drug delivery system, flow rate of 50 ml or greater per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96361","name":"Hydrate iv infusion add-on","description":"Intravenous infusion, hydration; each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61107","name":"Tdh pnxr implt ventr cath","description":"Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for implanting ventricular catheter, pressure recording device, or other intracerebral monitoring device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99153","name":"Mod sed same phys/qhp ea","description":"Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77750","name":"Infuse radioactive materials","description":"Infusion or instillation of radioelement solution (includes 3-month follow-up care)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28450","name":"Tx tarsal b1 fx w/o mnpj ea","description":"Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56420","name":"I&d bartholins gland abscess","description":"Incision and drainage of bartholins gland abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4387","name":"Ost clsd pouch w att st barr","description":"Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85540","name":"Wbc alkaline phosphatase","description":"Leukocyte alkaline phosphatase with count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4353","name":"Intermittent urinary cath","description":"Intermittent urinary catheter, with insertion supplies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27781","name":"Treatment of fibula fracture","description":"Closed treatment of proximal fibula or shaft fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27245","name":"Treat thigh fracture","description":"Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81286","name":"Fxn gene full gene sequence","description":"Fxn (frataxin) (eg, friedreich ataxia) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2007","name":"Post-d/c h vst ext pt 30 m","description":"Limited (30 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient faci","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4431","name":"Ost pch urine w barrier/tapv","description":"Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93511","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0485T","name":"Oct mid ear i&r unilateral","description":"Optical coherence tomography (oct) of middle ear, with interpretation and report; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25400","name":"Repair radius or ulna","description":"Repair of nonunion or malunion, radius or ulna; without graft (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70482","name":"Ct orbit/ear/fossa w/o&w/dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2310","name":"Lens sphc trifocal 4.25-7/>6","description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32220","name":"Release of lung","description":"Decortication, pulmonary (separate procedure); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83068","name":"Hemoglobin unstable screen","description":"Hemoglobin; unstable, screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86689","name":"Htlv/hiv confirmj antibody","description":"Antibody; htlv or hiv antibody, confirmatory test (eg, western blot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51726","name":"Complex cystometrogram","description":"Complex cystometrogram (ie, calibrated electronic equipment);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67318","name":"Revise eye muscle(s)","description":"Strabismus surgery, any procedure, superior oblique muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20220","name":"Bone biopsy trocar/ndl supfc","description":"Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43405","name":"Ligate/staple esophagus","description":"Ligation or stapling at gastroesophageal junction for pre-existing esophageal perforation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1202.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31287","name":"Nasal/sinus endoscopy surg","description":"Nasal/sinus endoscopy, surgical, with sphenoidotomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36483","name":"Endoven ther chem adhes sbsq","description":"Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46610","name":"Anoscopy remove lesion","description":"Anoscopy; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33684","name":"Clsr 1 vsd w/wo patch w/vlvt","description":"Closure of single ventricular septal defect, with or without patch; with pulmonary valvotomy or infundibular resection (acyanotic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50570","name":"Kidney endoscopy","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":396.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33774","name":"Rpr tga atrial baffle px","description":"Repair of transposition of the great arteries, atrial baffle procedure (eg, mustard or senning type) with cardiopulmonary bypass;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83722","name":"Lipoprtn dir meas sd ldl chl","description":"Lipoprotein, direct measurement; small dense ldl cholesterol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50940","name":"Release of ureter","description":"Deligation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35226","name":"Repair blood vessel dir lxtr","description":"Repair blood vessel, direct; lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":728.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21320","name":"Clsd tx nsl fx w/mnpj&stablj","description":"Closed treatment of nasal bone fracture with manipulation; with stabilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72265","name":"Myelography l-s spine","description":"Myelography, lumbosacral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27340","name":"Removal of kneecap bursa","description":"Excision, prepatellar bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":311.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27788","name":"Treatment of ankle fracture","description":"Closed treatment of distal fibular fracture (lateral malleolus); with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99050","name":"Medical services after hrs","description":"Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, saturday or sunday), in addition to basic service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61864","name":"Implant neuroelectrde addl","description":"Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4411","name":"Ost skn barr extnd =4sq","description":"Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75660","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":257.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70546","name":"Mr angiograph head w/o&w/dye","description":"Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93453","name":"R&l hrt cath w/ventriclgrphy","description":"Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58323","name":"Sperm washing","description":"Sperm washing for artificial insemination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53601","name":"Dilate urethra stricture","description":"Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27355","name":"Remove femur lesion","description":"Excision or curettage of bone cyst or benign tumor of femur;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":509.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0462","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21554","name":"Exc neck tum deep 5 cm/>","description":"Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0435","name":"Oral hiv-1/hiv-2 screen","description":"Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78011","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74183","name":"Mri abd w/o cntr flwd cntr","description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":307.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65770","name":"Keratoprosthesis","description":"Keratoprosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":836.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5814","name":"Endo knee-shin hydral swg ph","description":"Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1809.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1860","name":"Ko supracondylar socket mold","description":"Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80435","name":"Insulin tolerance panel","description":"Insulin tolerance panel; for growth hormone deficiency this panel must include the following: glucose (82947 x 5) human growth hormone (hgh) (83003 x 5)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4351","name":"Straight tip urine catheter","description":"Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5690","name":"Bk waist belt padded and lin","description":"Addition to lower extremity, below knee, waist belt, padded and lined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5644","name":"Above knee wood socket","description":"Addition to lower extremity, above knee, wood socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26565","name":"Correct metacarpal flaw","description":"Osteotomy; metacarpal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88153","name":"Cytopath c/v redo","description":"Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92570","name":"Acoustic immitance testing","description":"Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43635","name":"Removal of stomach partial","description":"Vagotomy when performed with partial distal gastrectomy (list separately in addition to code[s] for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87476","name":"Lyme dis dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); borrelia burgdorferi, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64615","name":"Chemodenerv musc migraine","description":"Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82627","name":"Dehydroepiandrosterone","description":"Dehydroepiandrosterone-sulfate (dhea-s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14020","name":"Tis trnfr s/a/l 10 sq cm/<","description":"Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":431.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37605","name":"Ligation int/com carotid art","description":"Ligation; internal or common carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":650.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0500","name":"Ippb all types","description":"Ippb machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82530","name":"Cortisol free","description":"Cortisol; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10120","name":"Inc&rmvl fb subq tiss smpl","description":"Incision and removal of foreign body, subcutaneous tissues; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24301","name":"Musc/tdn transfer upr a/e 1","description":"Muscle or tendon transfer, any type, upper arm or elbow, single (excluding 24320-24331)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":631.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53660","name":"Dilation of urethra","description":"Dilation of female urethra including suppository and/or instillation; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0247","name":"Trans bench w/wo comm open","description":"Transfer bench for tub or toilet with or without commode opening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67332","name":"Rerevise eye muscles add-on","description":"Strabismus surgery on patient with scarring of extraocular muscles (eg, prior ocular injury, strabismus or retinal detachment surgery) or restrictive myopathy (eg, dysthyroid ophthalmopathy) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00930","name":"Anes px male gent orchiopexy","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); orchiopexy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3216","name":"Orthoped ladies shoes dpth i","description":"Orthopedic footwear, ladies shoe, depth inlay, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62291","name":"Njx px discography crv/thrc","description":"Injection procedure for discography, each level; cervical or thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6213","name":"Foam drg >16<=48 sq in w/bdr","description":"Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6883","name":"Replc sockt below e/w disa","description":"Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1050.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4672","name":"Drainage ext line, dialysis","description":"Drainage extension line, sterile, for dialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83586","name":"Assay 17- ketosteroids","description":"Ketosteroids, 17- (17-ks); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00934","name":"Anes rad amp penis ingun lym","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21245","name":"Reconstruction of jaw","description":"Reconstruction of mandible or maxilla, subperiosteal implant; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61616","name":"Resect/excise lesion skull","description":"Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or c1-c3 vertebral bodies; intradural, including dural repair, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2975.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67908","name":"Repair eyelid defect","description":"Repair of blepharoptosis; conjunctivo-tarso-mullers muscle-levator resection (eg, fasanella-servat type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23075","name":"Exc shoulder les sc < 3 cm","description":"Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52276","name":"Cystoscopy and treatment","description":"Cystourethroscopy with direct vision internal urethrotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29825","name":"Sho arthrs srg lss&rescj ads","description":"Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78458","name":"Ven thrombosis images bilat","description":"Venous thrombosis imaging, venogram; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21813","name":"Treatment of rib fracture","description":"Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":870.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93923","name":"Upr/lxtr art stdy 3+ lvls","description":"Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional doppler wave","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57220","name":"Revision of urethra","description":"Plastic operation on urethral sphincter, vaginal approach (eg, kelly urethral plication)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62304","name":"Myelography lumbar injection","description":"Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50300","name":"Remove cadaver donor kidney","description":"Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1816","name":"Sps/pass ankle device","description":"Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4386","name":"Non-pneum walk boot pre cst","description":"Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26860","name":"Fusion of finger joint","description":"Arthrodesis, interphalangeal joint, with or without internal fixation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0248","name":"Demonstrate use home inr mon","description":"Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69805","name":"Explore inner ear","description":"Endolymphatic sac operation; without shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25392","name":"Shorten radius & ulna","description":"Osteoplasty, radius and ulna; shortening (excluding 64876)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70200","name":"X-ray exam of eye sockets","description":"Radiologic examination; orbits, complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84134","name":"Assay of prealbumin","description":"Prealbumin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55873","name":"Cryoablate prostate","description":"Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43232","name":"Esophagoscopy w/us needle bx","description":"Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99254","name":"Ip/obs cnsltj new/est mod 60","description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2314","name":"Lens sphcyl trifocal over 12","description":"Spherocylinder, trifocal, sphere over plus or minus 12.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28220","name":"Release of foot tendon","description":"Tenolysis, flexor, foot; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":364.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1900","name":"Afo sprng wir drsflx calf bd","description":"Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62005","name":"Treat skull fracture","description":"Elevation of depressed skull fracture; compound or comminuted, extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4100","name":"Repl leath cuff kafo prox th","description":"Replace leather cuff kafo, proximal thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32940","name":"Revision of lung","description":"Pneumonolysis, extraperiosteal, including filling or packing procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":984.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33620","name":"Apply r&l pulm art bands","description":"Application of right and left pulmonary artery bands (eg, hybrid approach stage 1)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21485","name":"Cltx tmprmand dislc comp","description":"Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97537","name":"Community/work reintegration","description":"Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43651","name":"Laparoscopy vagus nerve","description":"Laparoscopy, surgical; transection of vagus nerves, truncal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45400","name":"Laparoscopic proc","description":"Laparoscopy, surgical; proctopexy (for prolapse)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95065","name":"Dir nsl mucous membrane test","description":"Direct nasal mucous membrane test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77002","name":"Needle localization by xray","description":"Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81337","name":"Smn1 gen nown famil seq vrnt","description":"Smn1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; known familial sequence variant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0325","name":"Urinal male jug-type","description":"Urinal; male, jug-type, any material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1070","name":"Trapezius sling","description":"Addition to ctlso or scoliosis orthosis, trapezius sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30905","name":"Control of nosebleed","description":"Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9490","name":"Cmmi mod home visit","description":"Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/man","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74250","name":"X-ray xm sm int 1cntrst std","description":"Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31579","name":"Laryngoscopy telescopic","description":"Laryngoscopy, flexible or rigid telescopic, with stroboscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23172","name":"Sequestrectomy scapula","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), scapula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":477.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36400","name":"Vnpnxr<3yrs phy/qhp fem/jug","description":"Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21015","name":"Resect face/scalp tum < 2 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; less than 2 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":585.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29866","name":"Autgrft implnt knee w/scope","description":"Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93306","name":"Tte w/doppler complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81177","name":"Atn1 gene detc abnor alleles","description":"Atn1 (atrophin 1) (eg, dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4402","name":"Lubricant per ounce","description":"Lubricant, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87164","name":"Dark field exam spec collj","description":"Dark field examination, any source (eg, penile, vaginal, oral, skin); includes specimen collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62284","name":"Injection for myelogram","description":"Injection procedure for myelography and/or computed tomography, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70553","name":"Mri brain stem w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94070","name":"Evaluation of wheezing","description":"Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4256","name":"Calibrator solution/chips","description":"Normal, low and high calibrator solution / chips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","KL","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27705","name":"Osteotomy tibia","description":"Osteotomy; tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":635.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27831","name":"Treat lower leg dislocation","description":"Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25170","name":"Resect radius/ulnar tumor","description":"Radical resection of tumor, radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64520","name":"N block lumbar/thoracic","description":"Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93352","name":"Admin ecg contrast agent","description":"Use of echocardiographic contrast agent during stress echocardiography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29804","name":"Jaw arthroscopy/surgery","description":"Arthroscopy, temporomandibular joint, surgical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":493.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0426","name":"Inpt/ed teleconsult50","description":"Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2324","name":"Chin cup interface","description":"Power wheelchair accessory, chin cup for chin control interface","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15111","name":"Epidrm agrft t/a/l ea addl","description":"Epidermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33965","name":"Ecmo/ecls rmvl perph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5629","name":"Below knee acrylic socket","description":"Addition to lower extremity, below knee, acrylic socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57522","name":"Conization of cervix","description":"Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69631","name":"Repair eardrum structures","description":"Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82690","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78434","name":"Aqmbf pet rest & rx stress","description":"Absolute quantitation of myocardial blood flow (aqmbf), positron emission tomography (pet), rest and pharmacologic stress (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87540","name":"Legion pneumo dna dir prob","description":"Infectious agent detection by nucleic acid (dna or rna); legionella pneumophila, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93228","name":"Remote 30 day ecg rev/report","description":"External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ecg data storage (retrievable with query) with ecg triggered and patient selected events transmitted to a remote attended surveillance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84439","name":"Assay of free thyroxine","description":"Thyroxine; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76885","name":"Us exam infant hips dynamic","description":"Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35632","name":"Bpg ilio-celiac","description":"Bypass graft, with other than vein; ilio-celiac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1598.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43820","name":"Gastrojejunostomy wo vagotmy","description":"Gastrojejunostomy; without vagotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00626","name":"Anes thrc spine w/1 lng vent","description":"Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61026","name":"Injection into brain canal","description":"Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24620","name":"Cltx monteggia fx dislc elbw","description":"Closed treatment of monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":466.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14350","name":"Filleted finger/toe flap","description":"Filleted finger or toe flap, including preparation of recipient site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":423.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74305","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65772","name":"Correction of astigmatism","description":"Corneal relaxing incision for correction of surgically induced astigmatism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72070","name":"X-ray exam thorac spine 2vws","description":"Radiologic examination, spine; thoracic, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72159","name":"Mr angio spine w/o&w/dye","description":"Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36800","name":"Insertion of cannula","description":"Insertion of cannula for hemodialysis, other purpose (separate procedure); vein to vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42281","name":"Insertion palate prosthesis","description":"Insertion of pin-retained palatal prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24577","name":"Cltx humrl cndylr fx w/mnpj","description":"Closed treatment of humeral condylar fracture, medial or lateral; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76511","name":"Oph us dx quan a-scan only","description":"Ophthalmic ultrasound, diagnostic; quantitative a-scan only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46275","name":"Remove anal fist inter","description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":435.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88177","name":"Cytp fna eval ea addl","description":"Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75825","name":"Vein x-ray trunk","description":"Venography, caval, inferior, with serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70320","name":"Full mouth x-ray of teeth","description":"Radiologic examination, teeth; complete, full mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81345","name":"Tert gene targeted seq alys","description":"Tert (telomerase reverse transcriptase) (eg, thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (eg, promoter region)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19030","name":"Njx px only mam ducto/glcto","description":"Injection procedure only for mammary ductogram or galactogram","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94150","name":"Vital capacity test","description":"Vital capacity, total (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68760","name":"Close tear duct opening","description":"Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47015","name":"Lapt aspir&/njx hep prst cst","description":"Laparotomy, with aspiration and/or injection of hepatic parasitic (eg, amoebic or echinococcal) cyst(s) or abscess(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":974.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52214","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":590.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3640","name":"Shoe dennis browne splint bo","description":"Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21335","name":"Open tx nose & septal fx","description":"Open treatment of nasal fracture; with concomitant open treatment of fractured septum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77280","name":"Ther rad simulaj field smpl","description":"Therapeutic radiology simulation-aided field setting; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96522","name":"Refill/maint pump/resvr syst","description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25685","name":"Optx trns-scphprlnr fx dislc","description":"Open treatment of trans-scaphoperilunar type of fracture dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":620.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94070","name":"Evaluation of wheezing","description":"Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59020","name":"Fetal contract stress test","description":"Fetal contraction stress test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43621","name":"Removal of stomach","description":"Gastrectomy, total; with roux-en-y reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1902.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1832","name":"Ko adj jnt pos r sup pre cst","description":"Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26705","name":"Treat knuckle dislocation","description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38207","name":"Cryopreserve stem cells","description":"Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35355","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; iliofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45130","name":"Excision of rectal prolapse","description":"Excision of rectal procidentia, with anastomosis; perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":863.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77370","name":"Radiation physics consult","description":"Special medical radiation physics consultation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00524","name":"Anes clsd ch px pneumocents","description":"Anesthesia for closed chest procedures; pneumocentesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96368","name":"Ther/diag concurrent inf","description":"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32997","name":"Total lung lavage","description":"Total lung lavage (unilateral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0135","name":"Walker folding adjust/fixed","description":"Walker, folding (pickup), adjustable or fixed height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4430","name":"Ost urine pch w b/bltin conv","description":"Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86162","name":"Complement total (ch50)","description":"Complement; total hemolytic (ch50)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50592","name":"Perc rf ablate renal tumor","description":"Ablation, 1 or more renal tumor(s), percutaneous, unilateral, radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2586.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5093","name":"Ostomy accessory convex inse","description":"Ostomy accessory; convex insert","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58552","name":"Laparo-vag hyst incl t/o","description":"Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73100","name":"X-ray exam of wrist","description":"Radiologic examination, wrist; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72082","name":"X-ray exam entire spi 2/3 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25650","name":"Cltx ulnar styloid fracture","description":"Closed treatment of ulnar styloid fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95885","name":"Musc tst done w/nerv tst lim","description":"Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46916","name":"Cryosurgery anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96132","name":"Nrpsyc tst eval phys/qhp 1st","description":"Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the pati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99310","name":"Sbsq nf care high mdm 45","description":"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 45 minutes must be met or exc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01490","name":"Anes lwr leg cst app rmv/rpr","description":"Anesthesia for lower leg cast application, removal, or repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25600","name":"Cltx dst rdl fx/ephys sep wo","description":"Closed treatment of distal radial fracture (eg, colles or smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":274.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5071","name":"Urinary pouch w/barrier","description":"Ostomy pouch, urinary; with barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70460","name":"Ct head/brain w/dye","description":"Computed tomography, head or brain; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82136","name":"Amino acids quant 2-5","description":"Amino acids, 2 to 5 amino acids, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76821","name":"Middle cerebral artery echo","description":"Doppler velocimetry, fetal; middle cerebral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35286","name":"Rpr blvsl grf oth/th vn lxtr","description":"Repair blood vessel with graft other than vein; lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":819.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93282","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31375","name":"Partial removal of larynx","description":"Partial laryngectomy (hemilaryngectomy); laterovertical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1465.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0500","name":"Filters elec/combo vad, rep","description":"Filters for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01652","name":"Anes art sho&ax ax-brch arsm","description":"Anesthesia for procedures on arteries of shoulder and axilla; axillary-brachial aneurysm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21145","name":"Rcnstj mdfc lefort i 1 w/grf","description":"Reconstruction midface, lefort i; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2383","name":"Insert, pneum wheel drive","description":"Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67515","name":"Inject/treat eye socket","description":"Injection of medication or other substance into tenons capsule","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0190","name":"Cerv collar supp adj cerv ba","description":"Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84022","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88104","name":"Cytopath fl nongyn smears","description":"Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1150","name":"Wheelchair standard w/ leg r","description":"Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01210","name":"Anes open px hip joint nos","description":"Anesthesia for open procedures involving hip joint; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4536","name":"Reusable pull-on any size","description":"Incontinence product, protective underwear/pull-on, reusable, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64820","name":"Sympathectomy digital artery","description":"Sympathectomy; digital arteries, each digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":605.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0320","name":"Two-way audio and video hhs","description":"Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0635","name":"Patient lift electric","description":"Patient lift, electric with seat or sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21454","name":"Optx mndblr fx xtrnl fixj","description":"Open treatment of mandibular fracture with external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":405.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92552","name":"Pure tone audiometry air","description":"Pure tone audiometry (threshold); air only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0184","name":"Dry pressure mattress","description":"Dry pressure mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4673","name":"Ext line w easy lock connect","description":"Extension line with easy lock connectors, used with dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27400","name":"Revise thigh muscles/tendons","description":"Transfer, tendon or muscle, hamstrings to femur (eg, eggers type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86904","name":"Blood typing patient serum","description":"Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38760","name":"Remove groin lymph nodes","description":"Inguinofemoral lymphadenectomy, superficial, including cloquets node (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24538","name":"Prq skel fix sprcndlr hum fx","description":"Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82010","name":"Ketone bodys quan","description":"Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64568","name":"Opn impltj crnl nrv nea&pg","description":"Open implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25415","name":"Repair radius & ulna","description":"Repair of nonunion or malunion, radius and ulna; without graft (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1970","name":"Afo plastic molded w/ankle j","description":"Ankle foot orthosis, plastic with ankle joint, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56821","name":"Colposcopy vulva w/biopsy","description":"Colposcopy of the vulva; with biopsy(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38120","name":"Laparoscopy splenectomy","description":"Laparoscopy, surgical, splenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":707.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29891","name":"Arthr ank ostchn df tal&/tib","description":"Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50953","name":"Endoscopy of ureter","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34707","name":"Evasc rpr ilio-iliac ndgft","description":"Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1016.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81210","name":"Braf gene","description":"Braf (b-raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, v600 variant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21050","name":"Removal of jaw joint","description":"Condylectomy, temporomandibular joint (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":701.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2115","name":"Lens lenticular bifocal","description":"Lenticular, (myodisc), per lens, single vision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61606","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; intradural, including dural repair, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77001","name":"Fluoroguide for vein device","description":"Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic su","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57423","name":"Repair paravag defect lap","description":"Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96167","name":"Hlth bhv ivntj fam 1st 30","description":"Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0617","name":"Automatic ext defibrillator","description":"External defibrillator with integrated electrocardiogram analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92025","name":"Cptrized corneal topography","description":"Computerized corneal topography, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68360","name":"Revise eyelid lining","description":"Conjunctival flap; bridge or partial (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78015","name":"Thyroid met imaging","description":"Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77768","name":"Hdr rdncl skn surf brachytx","description":"Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29305","name":"Appl hip spica cast 1 leg","description":"Application of hip spica cast; 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95980","name":"Io anal gast n-stim init","description":"Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44620","name":"Repair bowel opening","description":"Closure of enterostomy, large or small intestine;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37565","name":"Ligation int jugular vein","description":"Ligation, internal jugular vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27393","name":"Lengthening of thigh tendon","description":"Lengthening of hamstring tendon; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4209","name":"5+ cc sterile syringe&needle","description":"Syringe with needle, sterile 5 cc or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43217","name":"Esophagoscopy snare les remv","description":"Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82633","name":"Desoxycorticosterone","description":"Desoxycorticosterone, 11-","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33019","name":"Perq prcrd drg insj cath ct","description":"Pericardial drainage with insertion of indwelling catheter, percutaneous, including ct guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26725","name":"Treat finger fracture each","description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":281.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27185","name":"Revision of femur epiphysis","description":"Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84152","name":"Assay of psa complexed","description":"Prostate specific antigen (psa); complexed (direct measurement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99309","name":"Sbsq nf care moderate mdm 30","description":"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0861","name":"Pwc gp3 std mult pow opt s/b","description":"Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89300","name":"Semen analysis w/huhner","description":"Semen analysis; presence and/or motility of sperm including huhner test (post coital)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93982","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96375","name":"Tx/pro/dx inj new drug addon","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58672","name":"Laparoscopy fimbrioplasty","description":"Laparoscopy, surgical; with fimbrioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43245","name":"Egd dilate stricture","description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64795","name":"Biopsy of nerve","description":"Biopsy of nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76811","name":"Ob us detailed sngl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50547","name":"Laparo removal donor kidney","description":"Laparoscopy, surgical; donor nephrectomy (including cold preservation), from living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52648","name":"Laser surgery of prostate","description":"Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78278","name":"Acute gi blood loss imaging","description":"Acute gastrointestinal blood loss imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27562","name":"Treat kneecap dislocation","description":"Closed treatment of patellar dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34201","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33521","name":"Cabg artery-vein four","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97164","name":"Pt re-eval est plan care","description":"Re-evaluation of physical therapy established plan of care, requiring these components: an examination including a review of history and use of standardized tests and measures is required; and revised plan of care using a standardized patient assessment instrument and/or measurable assessment of fun","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31615","name":"Trcheobrnchsc est trachs inc","description":"Tracheobronchoscopy through established tracheostomy incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2300","name":"Lens sphere trifocal 4.00d","description":"Sphere, trifocal, plano to plus or minus 4.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26105","name":"Biopsy finger joint lining","description":"Arthrotomy with biopsy; metacarpophalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6881","name":"Term dev auto grasp feature","description":"Automatic grasp feature, addition to upper limb electric prosthetic terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1991.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63086","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53502","name":"Repair of urethra injury","description":"Urethrorrhaphy, suture of urethral wound or injury, female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78707","name":"K flow/funct image w/o drug","description":"Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2206","name":"Lens sphcy bifocal 4.00d/ove","description":"Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24126","name":"Exc/crtg b1 cst/tum rds algr","description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92610","name":"Evaluate swallowing function","description":"Evaluation of oral and pharyngeal swallowing function","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22612","name":"Arthrd pst tq 1ntrspc lumbar","description":"Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1394.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26587","name":"Reconstruct extra finger","description":"Reconstruction of polydactylous digit, soft tissue and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28272","name":"Release of toe joint each","description":"Capsulotomy; interphalangeal joint, each joint (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4432","name":"Os pch urine w bar/fange/tap","description":"Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0666","name":"Pneumatic appliance half leg","description":"Non-segmental pneumatic appliance for use with pneumatic compressor, half leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31755","name":"Trachplsty trchphryngl fstlj","description":"Tracheoplasty; tracheopharyngeal fistulization, each stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76536","name":"Us exam of head and neck","description":"Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92626","name":"Eval aud funcj 1st hour","description":"Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24134","name":"Sequestrectomy shft/dstl hum","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":630.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66175","name":"Trluml dil aq o/f can w/st","description":"Transluminal dilation of aqueous outflow canal (eg, canaloplasty); with retention of device or stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":594.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78635","name":"Csf ventriculography","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":274.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01990","name":"Physiol support hrvg organs","description":"Physiological support for harvesting of organ(s) from brain-dead patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4528","name":"Adult size pull-on xl","description":"Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41115","name":"Excision of tongue fold","description":"Excision of lingual frenum (frenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":196.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48548","name":"Fuse pancreas and bowel","description":"Pancreaticojejunostomy, side-to-side anastomosis (puestow-type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1392.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28307","name":"Incision of metatarsal","description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal with autograft (other than first toe)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":502.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29850","name":"Knee arthroscopy/surgery","description":"Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0398","name":"Home sleep test/type 2 porta","description":"Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2219","name":"Lens bifocal seg width over","description":"Bifocal seg width over 28 mm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21045","name":"Extensive jaw surgery","description":"Excision of malignant tumor of mandible; radical resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":983.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5500","name":"Init bk ptb plaster direct","description":"Initial, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81528","name":"Oncology colorectal scr","description":"Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 dna markers (kras mutations, promoter methylation of ndrg4 and bmp3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93314","name":"Echo transesophageal","description":"Echocardiography, transesophageal, real-time with image documentation (2d) (with or without m-mode recording); image acquisition, interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8618","name":"Coch implant tran cable repl","description":"Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2680","name":"Thorac cont lat support upri","description":"Addition to lower extremity, thoracic control, lateral support uprights","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37735","name":"Lig&div&compl strpg saph vn","description":"Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":314.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67331","name":"Eye surgery follow-up add-on","description":"Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88385","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":327.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50727","name":"Revise ureter","description":"Revision of urinary-cutaneous anastomosis (any type urostomy);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":414.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87525","name":"Hepatitis g dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis g, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50845","name":"Appendico-vesicostomy","description":"Cutaneous appendico-vesicostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1012.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2114","name":"Spherocylinder over 12.00d","description":"Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36222","name":"Place cath carotid/inom art","description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1024.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0969","name":"Wheelchair narrowing device","description":"Narrowing device, wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0372","name":"Md service required for pmd","description":"Physician service required to establish and document the need for a power mobility device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01952","name":"Anes 2&3 burn 4-9% tbsa","description":"Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (tbsa) treated during anesthesia and surgery; between 4% and 9% of total body surface area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71260","name":"Ct thorax dx c+","description":"Computed tomography, thorax, diagnostic; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0049","name":"Alcohol/drug screening","description":"Alcohol and/or drug screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77417","name":"Ther radiology port image(s)","description":"Therapeutic radiology port image(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30435","name":"Revision of nose","description":"Rhinoplasty, secondary; intermediate revision (bony work with osteotomies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59400","name":"Obstetrical care","description":"Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22511","name":"Perq lumbosacral injection","description":"Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1458.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8687","name":"Implt nrostm pls gen dua rec","description":"Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8288.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78291","name":"Pertl-ven shunt patency test","description":"Peritoneal-venous shunt patency test (eg, for leveen, denver shunt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":207.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25215","name":"Removal of wrist bones","description":"Carpectomy; all bones of proximal row","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36160","name":"Establish access to aorta","description":"Introduction of needle or intracatheter, aortic, translumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26415","name":"Excision hand/finger tendon","description":"Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86696","name":"Herpes simplex type 2 test","description":"Antibody; herpes simplex, type 2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0605","name":"Vaporizer room type","description":"Vaporizer, room type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0806","name":"Pov group 2 std up to 300lbs","description":"Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64645","name":"Chemodenerv 1 extrem 5/> ea","description":"Chemodenervation of one extremity; each additional extremity, 5 or more muscles (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0764","name":"Functional neuromuscularstim","description":"Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76770","name":"Us exam abdo back wall comp","description":"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11982","name":"Remove drug implant device","description":"Removal, non-biodegradable drug delivery implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74445","name":"X-ray exam of penis","description":"Corpora cavernosography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27076","name":"Resect hip tum incl acetabul","description":"Radical resection of tumor; ilium, including acetabulum, both pubic rami, or ischium and acetabulum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2154.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35454","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":325.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84450","name":"Transferase (ast) (sgot)","description":"Transferase; aspartate amino (ast) (sgot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2389","name":"Foam caster tire","description":"Power wheelchair accessory, foam caster tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15788","name":"Chemical peel facial epidrm","description":"Chemical peel, facial; epidermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4640","name":"Alternating pressure pad","description":"Replacement pad for use with medically necessary alternating pressure pad owned by patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26850","name":"Fusion of knuckle","description":"Arthrodesis, metacarpophalangeal joint, with or without internal fixation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76885","name":"Us exam infant hips dynamic","description":"Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7522","name":"Trach/laryn tube stainless","description":"Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0441","name":"Stationary o2 contents, gas","description":"Stationary oxygen contents, gaseous, 1 months supply = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81166","name":"Brca1 gene full dup/del alys","description":"Brca1 (brca1, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G9678","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0314","name":"Counsel immune <21 16-30 m","description":"Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 16-30 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93642","name":"Ep evl 1/2chmb trnsvns cvdfb","description":"Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92286","name":"Ant sgm img i&r speclr mic","description":"Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69552","name":"Exc aurl glomus tum trnsmstd","description":"Excision aural glomus tumor; transmastoid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1269.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87186","name":"Sc std microdil/agar dil","description":"Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [mic] or breakpoint), each multi-antimicrobial, per plate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54161","name":"Circum 28 days or older","description":"Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24152","name":"Rad resection tum radial h/n","description":"Radical resection of tumor, radial head or neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64840","name":"Repair of leg nerve","description":"Suture of posterior tibial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40527","name":"Reconstruct lip with flap","description":"Excision of lip; full thickness, reconstruction with cross lip flap (abbe-estlander)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":480.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93925","name":"Lower extremity study","description":"Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5910","name":"Endo below knee alignable sy","description":"Addition, endoskeletal system, below knee, alignable system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43850","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1368.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86653","name":"Encephaltis st louis antbody","description":"Antibody; encephalitis, st. louis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37239","name":"Open/perq place stent ea add","description":"Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32484","name":"Segmentectomy","description":"Removal of lung, other than pneumonectomy; single segment (segmentectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1147.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76125","name":"Cine/video x-rays add-on","description":"Cineradiography/videoradiography to complement routine examination (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93227","name":"Xtrnl ecg rec<48 hr r&i","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2188","name":"Quadrilateral brim","description":"Addition to lower extremity fracture orthosis, quadrilateral brim","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36838","name":"Dist revas ligation hemo","description":"Distal revascularization and interval ligation (dril), upper extremity hemodialysis access (steal syndrome)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15769","name":"Grfg autol soft tiss dir exc","description":"Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65750","name":"Corneal transplant","description":"Keratoplasty (corneal transplant); penetrating (in aphakia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":751.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93745","name":"Set-up cardiovert-defibrill","description":"Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ecg, transmission of data to data repository, patient instruction in wearing system and patient re","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53605","name":"Dilate urethra stricture","description":"Dilation of urethral stricture or vesical neck by passage of sound or urethral dilator, male, general or conduction (spinal) anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0027","name":"Semen analysis","description":"Semen analysis; presence and/or motility of sperm excluding huhner","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20612","name":"Aspirate/inj ganglion cyst","description":"Aspiration and/or injection of ganglion cyst(s) any location","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75900","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54112","name":"Treat penis lesion graft","description":"Excision of penile plaque (peyronie disease); with graft greater than 5 cm in length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26460","name":"Incise hand/finger tendon","description":"Tenotomy, extensor, hand or finger, open, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99458","name":"Rpm tx mgmt ea addl 20 min","description":"Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring 1 real-time interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (list separately in","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41007","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37600","name":"Ligation xtrnl carotid art","description":"Ligation; external carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33954","name":"Ecmo/ecls insj prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":414.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36832","name":"Av fistula revision open","description":"Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88350","name":"Imfluor ea addl 1antb stn px","description":"Immunofluorescence, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77065","name":"Dx mammo incl cad uni","description":"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31512","name":"Removal of larynx lesion","description":"Laryngoscopy, indirect; with removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76805","name":"Ob us >/= 14 wks sngl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87516","name":"Hepatitis b dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis b virus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99427","name":"Prin care mgmt staff ea addl","description":"Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or de","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95923","name":"Autonomic nrv syst funj test","description":"Testing of autonomic nervous system function; sudomotor, including 1 or more of the following: quantitative sudomotor axon reflex test (qsart), silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74283","name":"Ther nma rdctj intus/obstrcj","description":"Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium ileus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5634","name":"Symes type poster opening so","description":"Addition to lower extremity, symes type, posterior opening (canadian) socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20610","name":"Drain/inj joint/bursa w/o us","description":"Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33478","name":"Revision of heart chamber","description":"Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21181","name":"Rcnst cntrg b9 tum crnl xtrc","description":"Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous dysplasia), extracranial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":621.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86153","name":"Cell enumeration phys interp","description":"Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01502","name":"Anes px art lower leg emblc","description":"Anesthesia for procedures on arteries of lower leg, including bypass graft; embolectomy, direct or with catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75885","name":"Vein x-ray liver w/hemodynam","description":"Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61541","name":"Incision of brain tissue","description":"Craniotomy with elevation of bone flap; for transection of corpus callosum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15826","name":"Rhytidectomy glblr frn lines","description":"Rhytidectomy; glabellar frown lines","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72295","name":"X-ray of lower spine disk","description":"Discography, lumbar, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00948","name":"Anes vag px crv cerclage","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); cervical cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4221","name":"Supp non-insulin inf cath/wk","description":"Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs  separately)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4481","name":"Tracheostoma filter","description":"Tracheostoma filter, any type, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27025","name":"Fasciotomy hip/thigh any typ","description":"Fasciotomy, hip or thigh, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40702","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 of 2 stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0672","name":"Removable soft interface le","description":"Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78816","name":"Pet image w/ct full body","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1228.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62140","name":"Crnop skull defect<5 cm diam","description":"Cranioplasty for skull defect; up to 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":915.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76000","name":"Fluoroscopy <1 hr phys/qhp","description":"Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57284","name":"Repair paravag defect open","description":"Paravaginal defect repair (including repair of cystocele, if performed); open abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0692","name":"Uvl sys panel 4 ft","description":"Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0295","name":"Hosp bed semi-elect w/o matt","description":"Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0505","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50553","name":"Kidney endoscopy","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00500","name":"Anes all px on esophagus","description":"Anesthesia for all procedures on esophagus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69745","name":"Repair facial nerve","description":"Suture facial nerve, intratemporal, with or without graft or decompression; including medial to geniculate ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50386","name":"Remove stent via transureth","description":"Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":598.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64834","name":"Repair of hand or foot nerve","description":"Suture of 1 nerve; hand or foot, common sensory nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":620.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00920","name":"Anes px male genitalia nos","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94452","name":"Hast w/i&r phys/qhp","description":"High altitude simulation test (hast), with interpretation and report by a physician or other qualified health care professional;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76881","name":"Us compl joint r-t w/img","description":"Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P2038","name":"Blood mucoprotein","description":"Mucoprotein, blood (seromucoid) (medical necessity procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33235","name":"Removal pacemaker electrode","description":"Removal of transvenous pacemaker electrode(s); dual lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0555","name":"Humidifier for use w/ regula","description":"Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93720","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1060","name":"Thoracic pad","description":"Addition to ctlso or scoliosis orthosis, thoracic pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58356","name":"Endometrial cryoablation","description":"Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1142.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75872","name":"Vein x-ray skull epidural","description":"Venography, epidural, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96542","name":"Chemotherapy injection","description":"Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95956","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":980.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0017","name":"Detach adjust armrest base","description":"Detachable, adjustable height armrest, base, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54860","name":"Removal of epididymis","description":"Epididymectomy; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86480","name":"Tb test cell immun measure","description":"Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46945","name":"Int hrhc lig 1 hroid w/o img","description":"Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33268","name":"Excl laa opn oth px any meth","description":"Exclusion of left atrial appendage, open, performed at the time of other sternotomy or thoracotomy procedure(s), any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92575","name":"Sensorineural acuity lvl tst","description":"Sensorineural acuity level test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99149","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6580","name":"Wrist/elbow bowden cable mol","description":"Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":777.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77435","name":"Sbrt management","description":"Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4543","name":"Adult disp brief/diap abv xl","description":"Adult sized disposable incontinence product, protective brief/diaper, above extra large, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22558","name":"Arthrd ant ntrbd min dsc lum","description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61720","name":"Incise skull/brain surgery","description":"Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; globus pallidus or thalamus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1157.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88372","name":"Protein analysis w/probe","description":"Protein analysis of tissue by western blot, with interpretation and report; immunological probe for band identification, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38500","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":219.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20225","name":"Bone biopsy trocar/ndl deep","description":"Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40654","name":"Rpr lip fth>1half ver ht/cpx","description":"Repair lip, full thickness; over one-half vertical height, or complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":449.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43231","name":"Esophagoscop ultrasound exam","description":"Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54308","name":"Reconstruction of urethra","description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69700","name":"Close mastoid fistula","description":"Closure postauricular fistula, mastoid (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2540","name":"Thigh/wght bear lacer molded","description":"Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S1040","name":"Cranial remolding orthosis","description":"Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":608.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27332","name":"Removal of knee cartilage","description":"Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial or lateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":543.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59618","name":"Attempted vbac delivery","description":"Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2512","name":"Cntct lens gas permbl bifocl","description":"Contact lens, gas permeable, bifocal, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75710","name":"Artery x-rays arm/leg","description":"Angiography, extremity, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37184","name":"Prim art m-thrmbc 1st vsl","description":"Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4927","name":"Non-sterile gloves","description":"Gloves, non-sterile, per 100","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36511","name":"Apheresis wbc","description":"Therapeutic apheresis; for white blood cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24305","name":"Tendon lngth upr a/e ea tdn","description":"Tendon lengthening, upper arm or elbow, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":484.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50728","name":"Revise ureter","description":"Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54640","name":"Orchiopexy ingun/scrot appr","description":"Orchiopexy, inguinal or scrotal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1200","name":"Furnsh initial orthosis only","description":"Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0438","name":"Ppps, initial visit","description":"Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98929","name":"Osteopath manj 9-10 regions","description":"Osteopathic manipulative treatment (omt); 9-10 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61595","name":"Transtemporal approach/skull","description":"Transtemporal approach to posterior cranial fossa, jugular foramen or midline skull base, including mastoidectomy, decompression of sigmoid sinus and/or facial nerve, with or without mobilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96164","name":"Hlth bhv ivntj grp 1st 30","description":"Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27842","name":"Treat ankle dislocation","description":"Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":413.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81236","name":"Ezh2 gene full gene sequence","description":"Ezh2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, myelodysplastic syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88366","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5270","name":"Tilt table locking hip sing","description":"Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70360","name":"X-ray exam of neck","description":"Radiologic examination; neck, soft tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1680","name":"Pelvic & hip control thigh c","description":"Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":567.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57267","name":"Insert mesh/pelvic flr addon","description":"Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81327","name":"Sept9 gen prmtr mthyltn alys","description":"Sept9 (septin9) (eg, colorectal cancer) promoter methylation analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69400","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36262","name":"Removal of infusion pump","description":"Removal of implanted intra-arterial infusion pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4158","name":"Ef ped complete intact nut","description":"Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26200","name":"Remove hand bone lesion","description":"Excision or curettage of bone cyst or benign tumor of metacarpal;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25332","name":"Revise wrist joint","description":"Arthroplasty, wrist, with or without interposition, with or without external or internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":706.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74713","name":"Mri fetal ea addl gestation","description":"Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95937","name":"Neuromuscular junction test","description":"Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92072","name":"Fitg c-lens keratoconus 1st","description":"Fitting of contact lens for management of keratoconus, initial fitting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45382","name":"Colonoscopy w/control bleed","description":"Colonoscopy, flexible; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":539.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32320","name":"Free/remove chest lining","description":"Decortication and parietal pleurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1275.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15832","name":"Exc excessive skin thigh","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43338","name":"Esoph lengthening","description":"Esophageal lengthening procedure (eg, collis gastroplasty or wedge gastroplasty) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01710","name":"Anes px nrv musc upr a&e nos","description":"Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56442","name":"Hymenotomy","description":"Hymenotomy, simple incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26105","name":"Biopsy finger joint lining","description":"Arthrotomy with biopsy; metacarpophalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":285.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47785","name":"Fuse bile ducts and bowel","description":"Anastomosis, roux-en-y, of intrahepatic biliary ducts and gastrointestinal tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2726.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27659","name":"Repair of leg tendon each","description":"Repair, flexor tendon, leg; secondary, with or without graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":382.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4392","name":"Replace afo soft interface","description":"Replacement, soft interface material, static afo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93657","name":"Tx l/r atrial fib addl","description":"Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76965","name":"Echo guidance radiotherapy","description":"Ultrasonic guidance for interstitial radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0516T","name":"Insj wcs lv eltrd only","description":"Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; electrode only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":327.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0002A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27380","name":"Repair of kneecap tendon","description":"Suture of infrapatellar tendon; primary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":510.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87329","name":"Giardia ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; giardia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00142","name":"Anes px on eye lens surgery","description":"Anesthesia for procedures on eye; lens surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21556","name":"Exc neck tum deep < 5 cm","description":"Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4630","name":"Repl bat t.e.n.s. own by pt","description":"Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76802","name":"Ob us < 14 wks addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93018","name":"Cv stress test i&r only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33881","name":"Evasc rpr ta ndgft xcov lsa","description":"Endovascular repair of thoracic aorta, including pre-procedure sizing and device selection, nonselective catheterization(s), all associated radiological supervision and interpretation; by deployment of an aorto-aortic tube endograft not involving coverage of the left subclavian artery origin and all","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1347.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10006","name":"Fna bx w/us gdn ea addl","description":"Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90947","name":"Dialysis repeated eval","description":"Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated evaluations by a physician or other qualified health care professional, with or without substantial revision of dialysis prescription","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68745","name":"Create tear duct drain","description":"Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6696","name":"Cus elbo skt in for con/atyp","description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95700","name":"Eeg cont rec w/vid eeg tech","description":"Electroencephalogram (eeg) continuous recording, with video when performed, setup, patient education, and takedown when performed, administered in person by eeg technologist, minimum of 8 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32556","name":"Insert cath pleura w/o image","description":"Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0472","name":"Rad w backup invasive intrfc","description":"Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93510","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1342.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67028","name":"Injection eye drug","description":"Intravitreal injection of a pharmacologic agent (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54112","name":"Treat penis lesion graft","description":"Excision of penile plaque (peyronie disease); with graft greater than 5 cm in length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":758.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84481","name":"Free assay (ft-3)","description":"Triiodothyronine t3; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85635","name":"Reptilase test","description":"Reptilase test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5680","name":"Bk thigh lacer non-molded","description":"Addition to lower extremity, below knee, thigh lacer, nonmolded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22207","name":"Incis spine 3 column lumbar","description":"Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2020","name":"Vision svcs frames purchases","description":"Frames, purchases","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78431","name":"Myocrd img pet rst&strs ct","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1906","name":"Afo multilig ank sup pre ots","description":"Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22850","name":"Remove spine fixation device","description":"Removal of posterior nonsegmental instrumentation (eg, harrington rod)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6687","name":"Frame typ socket bel elbow/w","description":"Upper extremity addition, frame type socket, below elbow or wrist disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2670","name":"Thorac cont paraspinal uprig","description":"Addition to lower extremity, thoracic control, paraspinal uprights","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59120","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38215","name":"Harvest stem cell concentrte","description":"Transplant preparation of hematopoietic progenitor cells; cell concentration in plasma, mononuclear, or buffy coat layer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q4038","name":"Cast sup shrt leg fiberglass","description":"Cast supplies, short leg cast, adult (11 years +), fiberglass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88362","name":"Nerve teasing preparations","description":"Nerve teasing preparations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86651","name":"Encephalitis californ antbdy","description":"Antibody; encephalitis, california (la crosse)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92136","name":"Ophthalmic biometry","description":"Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00851","name":"Anes iper px tubal ligation","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7005","name":"Nondisposable nebulizer set","description":"Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74280","name":"X-ray xm colon 2cntrst std","description":"Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high density barium and air) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61330","name":"Dcmprn orbit only transcrnl","description":"Decompression of orbit only, transcranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1638.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64907","name":"Nerve pedicle transfer","description":"Nerve pedicle transfer; second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1105.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95975","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58545","name":"Laparoscopic myomectomy","description":"Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57267","name":"Insert mesh/pelvic flr addon","description":"Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75726","name":"Artery x-rays abdomen","description":"Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27640","name":"Partial removal of tibia","description":"Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":695.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87253","name":"Virus inoculate tissue addl","description":"Virus isolation; tissue culture, additional studies or definitive identification (eg, hemabsorption, neutralization, immunofluorescence stain), each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87449","name":"Nos each organism ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; not otherwise specified, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21452","name":"Perq tx mndblr fx xtrnl fixj","description":"Percutaneous treatment of mandibular fracture, with external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":569.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24150","name":"Rad rescj tum dstl/shft hum","description":"Radical resection of tumor, shaft or distal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1314.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86226","name":"Dna antibody single strand","description":"Deoxyribonucleic acid (dna) antibody; single stranded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68745","name":"Create tear duct drain","description":"Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":472.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65220","name":"Remove foreign body from eye","description":"Removal of foreign body, external eye; corneal, without slit lamp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0559T","name":"Antmc mdl 3d print 1st cmpnt","description":"Anatomic model 3d-printed from image data set(s); first individually prepared and processed component of an anatomic structure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23466","name":"Repair shoulder capsule","description":"Capsulorrhaphy, glenohumeral joint, any type multidirectional instability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":934.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21366","name":"Opn tx complx malar w/grft","description":"Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1072.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28570","name":"Treat foot dislocation","description":"Closed treatment of talotarsal joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23035","name":"Incision bone cortex sho","description":"Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70150","name":"X-ray exam of facial bones","description":"Radiologic examination, facial bones; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4932","name":"Reusable rectal thermometer","description":"Rectal thermometer, reusable, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58671","name":"Laparoscopy tubal block","description":"Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or falope ring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5984","name":"Endoskeletal axial rotation","description":"All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":283.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35876","name":"Removal of clot in graft","description":"Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula); with revision of arterial or venous graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0691","name":"Uvl pnl 2 sq ft or less","description":"Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21155","name":"Rcnstj mdfc lefort iii w/i","description":"Reconstruction midface, lefort iii (extracranial), any type, requiring bone grafts (includes obtaining autografts); with lefort i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1767.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95249","name":"Cont gluc mntr pt prov eqp","description":"Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29887","name":"Arthrs knee srg drlg od fixj","description":"Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":633.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27646","name":"Resect fibula tumor","description":"Radical resection of tumor; fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1305.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44401","name":"Colonoscopy with ablation","description":"Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2175.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82495","name":"Assay of chromium","description":"Chromium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64866","name":"Fusion of facial/other nerve","description":"Anastomosis; facial-spinal accessory","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1062.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4392","name":"Replace afo soft interface","description":"Replacement, soft interface material, static afo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93526","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1719.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00936","name":"Anes rad amp pns ingun&ilac","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal and iliac lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4606","name":"Oxygen probe used w oximeter","description":"Oxygen probe for use with oximeter device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27637","name":"Remove/graft leg bone lesion","description":"Excision or curettage of bone cyst or benign tumor, tibia or fibula; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84315","name":"Body fluid specific gravity","description":"Specific gravity (except urine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9870","name":"Cmmi asyntelehealth >20min","description":"Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93224","name":"Xtrnl ecg rec up to 48 hrs","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25145","name":"Remove forearm bone lesion","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28470","name":"Cltx metatarsal fx wo mnp ea","description":"Closed treatment of metatarsal fracture; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0406","name":"Inpt/tele follow up 15","description":"Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6638","name":"Elec lock on manual pw elbow","description":"Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2105","name":"Spherocylinder 4.00d/4.25-6d","description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76810","name":"Ob us >/= 14 wks addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54200","name":"Injection px peyronie ds","description":"Injection procedure for peyronie disease;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43020","name":"Incision of esophagus","description":"Esophagotomy, cervical approach, with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22210","name":"Incis 1 vertebral seg cerv","description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33369","name":"Replace aortic valve w/byp","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33995","name":"Insj perq vad r hrt venous","description":"Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":314.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0482","name":"Cough stimulating device","description":"Cough stimulating device, alternating positive and negative airway pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15171","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92517","name":"Vemp test i&r cervical","description":"Vestibular evoked myogenic potential (vemp) testing, with interpretation and report; cervical (cvemp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62327","name":"Njx interlaminar lmbr/sac","description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5072","name":"Urinary pouch w/o barrier","description":"Ostomy pouch, urinary; without barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61868","name":"Implant neuroelectrde addl","description":"Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; each additional ar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1210","name":"Lateral thoracic extension","description":"Addition to tlso, (low profile), lateral thoracic extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32100","name":"Exploration of chest","description":"Thoracotomy; with exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":645.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99231","name":"Sbsq hosp ip/obs sf/low 25","description":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. when using total time on the date of the encounter for code selec","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74181","name":"Mri abdomen w/o contrast","description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93224","name":"Xtrnl ecg rec up to 48 hrs","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8330","name":"Truss add to std pad scrotal","description":"Truss, addition to standard pad, scrotal pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10005","name":"Fna bx w/us gdn 1st les","description":"Fine needle aspiration biopsy, including ultrasound guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01850","name":"Anes vein f/arm wrst&hnd nos","description":"Anesthesia for procedures on veins of forearm, wrist, and hand; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31628","name":"Bronchoscopy/lung bx each","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66600","name":"Remove iris and lesion","description":"Iridectomy, with corneoscleral or corneal section; for removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":524.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0978","name":"Axillary crutch extension","description":"Axillary crutch extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94644","name":"Cont inhlj tx 1st hour","description":"Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31515","name":"Laryngoscopy for aspiration","description":"Laryngoscopy direct, with or without tracheoscopy; for aspiration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29902","name":"Mcp joint arthroscopy surg","description":"Arthroscopy, metacarpophalangeal joint, surgical; with reduction of displaced ulnar collateral ligament (eg, stener lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45825","name":"Repair fistula w/colostomy","description":"Closure of rectourethral fistula; with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1282.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92920","name":"Prq trluml c angiop 1art&/br","description":"Percutaneous transluminal coronary angioplasty, single major coronary artery and/or its branch(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82387","name":"Assay of cathepsin-d","description":"Cathepsin-d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65286","name":"Repair of eye wound","description":"Repair of laceration; application of tissue glue, wounds of cornea and/or sclera","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":427.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00626","name":"Anes thrc spine w/1 lng vent","description":"Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21029","name":"Contour of face bone lesion","description":"Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":618.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28045","name":"Exc foot/toe tum deep <1.5cm","description":"Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); less than 1.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67314","name":"Revise eye muscle","description":"Strabismus surgery, recession or resection procedure; 1 vertical muscle (excluding superior oblique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":407.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9282","name":"Wig any type","description":"Wig, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25274","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":556.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35646","name":"Bpg aortobifemoral","description":"Bypass graft, with other than vein; aortobifemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1511.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99479","name":"Sbsq ic lbw inf 1,500-2,500","description":"Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant (present body weight of 1,500-2,500 grams)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27097","name":"Revision of hip tendon","description":"Release or recession, hamstring, proximal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":576.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27486","name":"Revise/replace knee joint","description":"Revision of total knee arthroplasty, with or without allograft; 1 component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1192.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6260","name":"Wound cleanser any type/size","description":"Wound cleansers, any type, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01967","name":"Neuraxl lbr anes vag dlvr","description":"Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52265","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4860","name":"Disposable catheter tips","description":"Disposable catheter tips for peritoneal dialysis, per 10","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43236","name":"Uppr gi scope w/submuc inj","description":"Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63170","name":"Incise spinal cord tract(s)","description":"Laminectomy with myelotomy (eg, bischof or drez type), cervical, thoracic, or thoracolumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1452.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38562","name":"Removal pelvic lymph nodes","description":"Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14302","name":"Tis trnfr addl 30 sq cm","description":"Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96165","name":"Hlth bhv ivntj grp ea addl","description":"Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0157","name":"Walker crutch attachment","description":"Crutch attachment, walker, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8020","name":"Mastectomy form","description":"Breast prosthesis, mastectomy form","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0296","name":"Visit to determ ldct elig","description":"Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00832","name":"Anes hernia repair vnt&incal","description":"Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68360","name":"Revise eyelid lining","description":"Conjunctival flap; bridge or partial (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":326.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72156","name":"Mri neck spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29583","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0946","name":"Fracture frame dual w cross","description":"Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84138","name":"Assay of pregnanetriol","description":"Pregnanetriol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82128","name":"Amino acids mult qual","description":"Amino acids; multiple, qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19281","name":"Perq device breast 1st imag","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85396","name":"Clotting assay whole blood","description":"Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27050","name":"Biopsy of sacroiliac joint","description":"Arthrotomy, with biopsy; sacroiliac joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":337.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0440","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83499","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82009","name":"Ketone bodys qual","description":"Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59074","name":"Fetal fluid drainage w/us","description":"Fetal fluid drainage (eg, vesicocentesis, thoracocentesis, paracentesis), including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85220","name":"Blooc clot factor v test","description":"Clotting; factor v (acg or proaccelerin), labile factor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34831","name":"Open aortoiliac prosth repr","description":"Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11311","name":"Shave skin lesion 0.6-1.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35013","name":"Repair artery rupture arm","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, axillary-brachial artery, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40525","name":"Reconstruct lip with flap","description":"Excision of lip; full thickness, reconstruction with local flap (eg, estlander or fan)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44394","name":"Colonoscopy w/snare","description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":327.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36473","name":"Endovenous mchnchem 1st vein","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27635","name":"Remove lower leg bone lesion","description":"Excision or curettage of bone cyst or benign tumor, tibia or fibula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78831","name":"Rp loclzj tum spect 2 areas","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect), minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":577.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95962","name":"Electrode stim brain add-on","description":"Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of attendance by a physician or other qualified health care professional (list separately i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7404","name":"Add ue prost a/e acrylic","description":"Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74262","name":"Ct colonography dx w/dye","description":"Computed tomographic (ct) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45110","name":"Removal of rectum","description":"Proctectomy; complete, combined abdominoperineal, with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1477.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69644","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1194.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0631","name":"Lso sag r an/pos pnl pre cst","description":"Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6686","name":"Suction socket","description":"Upper extremity addition, suction socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77417","name":"Ther radiology port image(s)","description":"Therapeutic radiology port image(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74175","name":"Cta abdomen w/contrast","description":"Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0015","name":"Detach non-adj ht armrst rep","description":"Detachable, non-adjustable height armrest, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0581T","name":"Abltj mal brst tum perq crtx","description":"Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":445.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4458","name":"Reusable enema bag","description":"Enema bag with tubing, reusable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5363","name":"Language screening","description":"Language screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28660","name":"Treat toe dislocation","description":"Closed treatment of interphalangeal joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0181","name":"Home health care supervision","description":"Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6900","name":"Hand restorat thumb/1 finger","description":"Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":881.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35637","name":"Bpg aortoiliac","description":"Bypass graft, with other than vein; aortoiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38115","name":"Repair of ruptured spleen","description":"Repair of ruptured spleen (splenorrhaphy) with or without partial splenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52240","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; large bladder tumor(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":316.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31231","name":"Nasal endoscopy dx","description":"Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69801","name":"Incise inner ear","description":"Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96113","name":"Devel tst phys/qhp ea addl","description":"Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67800","name":"Remove eyelid lesion","description":"Excision of chalazion; single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84133","name":"Assay of urine potassium","description":"Potassium; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0122","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31632","name":"Bronchoscopy/lung bx addl","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00635","name":"Anes dx/ther lumbar pnxr","description":"Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74262","name":"Ct colonography dx w/dye","description":"Computed tomographic (ct) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0969","name":"Wheelchair narrowing device","description":"Narrowing device, wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94618","name":"Pulmonary stress testing","description":"Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24136","name":"Sequestrectomy radial h/n","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":533.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45119","name":"Remove rectum w/reservoir","description":"Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, j-pouch), with diverting enterostomy when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1532.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43269","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":365.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70480","name":"Ct orbit/ear/fossa w/o dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64486","name":"Tap block unil by injection","description":"Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87470","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69990","name":"Microsurgery add-on","description":"Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85360","name":"Euglobulin lysis","description":"Euglobulin lysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69635","name":"Repair eardrum structures","description":"Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1000.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9500","name":"Tc99m sestamibi","description":"Technetium tc-99m sestamibi, diagnostic, per study dose","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96450","name":"Chemotherapy into cns","description":"Chemotherapy administration, into cns (eg, intrathecal), requiring and including spinal puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97167","name":"Ot eval high complex 60 min","description":"Occupational therapy evaluation, high complexity, requiring these components: an occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34502","name":"Reconstruct vena cava","description":"Reconstruction of vena cava, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69620","name":"Myringoplasty","description":"Myringoplasty (surgery confined to drumhead and donor area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":570.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39402","name":"Mediastinoscpy w/lmph nod bx","description":"Mediastinoscopy; with lymph node biopsy(ies) (eg, lung cancer staging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54336","name":"Revise penis/urethra","description":"1-stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78216","name":"Lvr&spleen img w/vasc flow","description":"Liver and spleen imaging; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63685","name":"Ins/rplc spi npg/rcvr pocket","description":"Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78185","name":"Spleen imaging","description":"Spleen imaging only, with or without vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33886","name":"Delayed plmt dstl xtn prosth","description":"Delayed placement of distal extension prosthesis(es) from the level of the left subclavian artery to the celiac artery, after endovascular repair of descending thoracic aorta, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological superv","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":835.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76941","name":"Echo guide for transfusion","description":"Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4450","name":"Non-waterproof tape","description":"Tape, non-waterproof, per 18 square inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["AW","GT","GQ","95","AU","AV","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66160","name":"Glaucoma surgery","description":"Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":593.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99383","name":"Prev visit new age 5-11","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27425","name":"Lat retinacular release open","description":"Lateral retinacular release, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2113","name":"Spherocylindr 7.25d/4.25-6d","description":"Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38243","name":"Transplj hematopoietic boost","description":"Hematopoietic progenitor cell (hpc); hpc boost","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19396","name":"Design custom breast implant","description":"Preparation of moulage for custom breast implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95811","name":"Polysom 6/>yrs cpap 4/> parm","description":"Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26665","name":"Treat thumb fracture","description":"Open treatment of carpometacarpal fracture dislocation, thumb (bennett fracture), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31620","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":211.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0980","name":"Peroneal straps pair pre ots","description":"Peroneal straps, prefabricated, off-the-shelf, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3214","name":"Benesch boot pair junior","description":"Benesch boot, pair, junior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8682","name":"Implt neurostim radiofq rec","description":"Implantable neurostimulator radiofrequency receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2903.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57107","name":"Vagnc compl rmvl paravag tis","description":"Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":913.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83036","name":"Hemoglobin glycosylated a1c","description":"Hemoglobin; glycosylated (a1c)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25250","name":"Removal of wrist prosthesis","description":"Removal of wrist prosthesis; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74174","name":"Cta abd&plvs w/contrast","description":"Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4233","name":"Alkalin batt for glucose mon","description":"Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","KL","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27279","name":"Arthrd si jt plmt tartclr dv","description":"Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, includes obtaining bone graft when performed, unilateral; placement of transarticular device(s) and/or intra-articular device(s) piercing the lateral or medial cortices of the ilium and the lateral cortex of the ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":765.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24566","name":"Prq skel fix epcndylr hum fx","description":"Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88263","name":"Chromosome analysis 45","description":"Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81343","name":"Ppp2r2b gen detc abnor allel","description":"Ppp2r2b (protein phosphatase 2 regulatory subunit bbeta) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25907","name":"Amputation follow-up surgery","description":"Amputation, forearm, through radius and ulna; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78494","name":"Heart image spect","description":"Cardiac blood pool imaging, gated equilibrium, spect, at rest, wall motion study plus ejection fraction, with or without quantitative processing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67440","name":"Explore/drain eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); with drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":770.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0366","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0504","name":"Pwr adpt pneum vad, rep veh","description":"Power adapter for pneumatic ventricular assist device, replacement only, vehicle type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53400","name":"Revise urethra stage 1","description":"Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, johannsen type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":649.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63610","name":"Stimulation of spinal cord","description":"Stereotactic stimulation of spinal cord, percutaneous, separate procedure not followed by other surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":533.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3765","name":"Ewhfo rigid w/o jnts cf","description":"Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26236","name":"Partial removal finger bone","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92250","name":"Fundus photography w/i&r","description":"Fundus photography with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5973","name":"Ank-foot sys dors-plant flex","description":"Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6655","name":"Standard control cable extra","description":"Upper extremity addition, standard control cable, extra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51727","name":"Cystometrogram w/up","description":"Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2384","name":"Pneumatic caster tire","description":"Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54125","name":"Removal of penis","description":"Amputation of penis; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":661.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73221","name":"Mri joint upr extrem w/o dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31651","name":"Bronchial valve addl insert","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78454","name":"Ht musc image planar mult","description":"Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2510","name":"Cntct gas permeable sphericl","description":"Contact lens, gas permeable, spherical, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01112","name":"Anes bone marrow aspir&/bx","description":"Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2107","name":"Spherocylinder 4.25d/12-2d","description":"Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"C9113","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5150","name":"Mold sckt ext knee shin sach","description":"Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2392","name":"Solid caster tire, integrate","description":"Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7007","name":"Adult electric hand","description":"Electric hand, switch or myoelectric controlled, adult","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92310","name":"Contact lens fitting ou","description":"Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86344","name":"Leukocyte phagocytosis","description":"Leukocyte phagocytosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67335","name":"Eye suture during surgery","description":"Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (list separately in addition to code for specific strabismus surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73615","name":"Contrast x-ray of ankle","description":"Radiologic examination, ankle, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97018","name":"Paraffin bath therapy","description":"Application of a modality to 1 or more areas; paraffin bath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6360","name":"Thoracic passive restor comp","description":"Interscapular thoracic, passive restoration (complete prosthesis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1580.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81234","name":"Dmpk gene detc abnor allele","description":"Dmpk (dm1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal (expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35470","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3120.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90869","name":"Tcran magn stim redetemine","description":"Therapeutic repetitive transcranial magnetic stimulation (tms) treatment; subsequent motor threshold re-determination with delivery and management","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8689","name":"External recharg sys intern","description":"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":840.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9482","name":"Remote e/m new pt 20mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination;  straightforward medical decis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31515","name":"Laryngoscopy for aspiration","description":"Laryngoscopy direct, with or without tracheoscopy; for aspiration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67922","name":"Repair eyelid defect","description":"Repair of entropion; thermocauterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99395","name":"Prev visit est age 18-39","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26420","name":"Repair/graft finger tendon","description":"Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":596.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8658","name":"Interphalangeal joint spacer","description":"Interphalangeal joint spacer, silicone or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94664","name":"Demo&/eval pt use inhaler","description":"Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or ippb device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62267","name":"Interdiscal perq aspir dx","description":"Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63272","name":"Excise intrspinl lesion lmbr","description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88230","name":"Tissue culture lymphocyte","description":"Tissue culture for non-neoplastic disorders; lymphocyte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0675","name":"Pneumatic compression device","description":"Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4376","name":"Drainable rubber pch w fcplt","description":"Ostomy pouch, drainable, with faceplate attached, rubber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82550","name":"Assay of ck (cpk)","description":"Creatine kinase (ck), (cpk); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23107","name":"Arthrt glenhumrl jt w/expl","description":"Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50020","name":"Drg perirnl/renal absc open","description":"Drainage of perirenal or renal abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":819.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75810","name":"Vein x-ray spleen/liver","description":"Splenoportography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0130","name":"Walker rigid adjust/fixed ht","description":"Walker, rigid (pickup), adjustable or fixed height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57020","name":"Colpocentesis sep px","description":"Colpocentesis (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99392","name":"Prev visit est age 1-4","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0194","name":"Air fluidized bed","description":"Air fluidized bed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77605","name":"Hyperthermia ext gen deep","description":"Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25210","name":"Removal of wrist bone","description":"Carpectomy; 1 bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19325","name":"Breast augmentation w/implt","description":"Breast augmentation with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24345","name":"Repr elbw med ligmnt w/tissu","description":"Repair medial collateral ligament, elbow, with local tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":587.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91306","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26416","name":"Graft hand or finger tendon","description":"Removal of synthetic rod and insertion of extensor tendon graft (includes obtaining graft), hand or finger, each rod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":750.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15792","name":"Chem peel nonfacial epidrm","description":"Chemical peel, nonfacial; epidermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25265","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":625.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99472","name":"Ped critical care subsq","description":"Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":330.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52344","name":"Cysto/uretero stricture tx","description":"Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5580","name":"Prep ak ischial thermo mold","description":"Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1286.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26262","name":"Resect distal finger tumor","description":"Radical resection of tumor, distal phalanx of finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":531.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21436","name":"Optx crnfcl sep comp mlt int","description":"Open treatment of craniofacial separation (lefort iii type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1717.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4230","name":"Infus insulin pump non needl","description":"Infusion set for external insulin pump, non needle cannula type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8606","name":"Synthetic implnt urinary 1ml","description":"Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86710","name":"Influenza virus antibody","description":"Antibody; influenza virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37765","name":"Stab phleb veins xtr 10-20","description":"Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87187","name":"Sc std microdil/agar mlc","description":"Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (mlc), each plate (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6704","name":"Term dev, sport/rec/work att","description":"Terminal device, sport/recreational/work attachment, any material, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52352","name":"Cystouretero w/stone remove","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80156","name":"Assay carbamazepine total","description":"Carbamazepine; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97035","name":"App mdlty 1+ultrasound ea 15","description":"Application of a modality to 1 or more areas; ultrasound, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4220","name":"Infusion pump refill kit","description":"Refill kit for implantable infusion pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26992","name":"Drainage of bone lesion","description":"Incision, bone cortex, pelvis and/or hip joint (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":836.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2391","name":"Solid caster tire","description":"Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67229","name":"Tr retinal les preterm inf","description":"Treatment of extensive or progressive retinopathy, 1 or more sessions, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (eg, retinopathy of prematurity), photocoagulation or cryotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95933","name":"Blink reflex test","description":"Orbicularis oculi (blink) reflex, by electrodiagnostic testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61534","name":"Removal of brain lesion","description":"Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1502.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0197","name":"Air pressure pad for mattres","description":"Air pressure pad for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33619","name":"Repair single ventricle","description":"Repair of single ventricle with aortic outflow obstruction and aortic arch hypoplasia (hypoplastic left heart syndrome) (eg, norwood procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00124","name":"Anes px ear otoscopy","description":"Anesthesia for procedures on external, middle, and inner ear including biopsy; otoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00928","name":"Anes male gent rad orch abd","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); radical orchiectomy, abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25230","name":"Partial removal of radius","description":"Radial styloidectomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33665","name":"Repair of heart defects","description":"Repair of intermediate or transitional atrioventricular canal, with or without atrioventricular valve repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1665.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2310","name":"Electro connect btw control","description":"Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4215","name":"Sterile needle","description":"Needle, sterile, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89055","name":"Leukocyte assessment fecal","description":"Leukocyte assessment, fecal, qualitative or semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27057","name":"Buttock fasciotomy w/dbrdmt","description":"Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle) with debridement of nonviable muscle, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23106","name":"Arthrotomy strnclav joint","description":"Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":419.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6221","name":"Gauze > 48 sq in w/border","description":"Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81518","name":"Onc brst mrna 11 genes","description":"Oncology (breast), mrna, gene expression profiling by real-time rt-pcr of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77416","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8001","name":"Breast prosthesis bra & form","description":"Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6684","name":"Test socket shldr disart/tho","description":"Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26746","name":"Treat finger fracture each","description":"Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":619.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51728","name":"Cystometrogram w/vp","description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85009","name":"Manual diff wbc count b-coat","description":"Blood count; manual differential wbc count, buffy coat","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33935","name":"Transplantation heart/lung","description":"Heart-lung transplant with recipient cardiectomy-pneumonectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00794","name":"Anes iper upr abd pncrtect","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; pancreatectomy, partial or total (eg, whipple procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84600","name":"Assay of volatiles","description":"Volatiles (eg, acetic anhydride, diethylether)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27616","name":"Resect leg/ankle tum 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43275","name":"Ercp remove forgn body duct","description":"Endoscopic retrograde cholangiopancreatography (ercp); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61333","name":"Expl orbit w/removal lesion","description":"Exploration of orbit (transcranial approach), with removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88142","name":"Cytopath c/v thin layer","description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33249","name":"Insj/rplcmt defib w/lead(s)","description":"Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":792.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01965","name":"Anes incompl/missed ab px","description":"Anesthesia for incomplete or missed abortion procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21502","name":"I&d dp abs/hmtm nck rib ostc","description":"Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; with partial rib ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":434.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27780","name":"Treatment of fibula fracture","description":"Closed treatment of proximal fibula or shaft fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64577","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":271.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93303","name":"Echo transthoracic","description":"Transthoracic echocardiography for congenital cardiac anomalies; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78432","name":"Myocrd img pet 2rtracer","description":"Myocardial imaging, positron emission tomography (pet), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76979","name":"Us trgt dyn mbubb ea addl","description":"Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate injection (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0012","name":"Ltwt portbl power whlchr","description":"Lightweight portable motorized/power wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83727","name":"Assay of lrh hormone","description":"Luteinizing releasing factor (lrh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7029","name":"Repl nasal pillow comb mask","description":"Nasal pillows for combination oral/nasal mask, replacement only, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40816","name":"Excision of mouth lesion","description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96920","name":"Excimer lsr psriasis<250sqcm","description":"Excimer laser treatment for psoriasis; total area less than 250 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63303","name":"Remov vert xdrl bdy lmbr/sac","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, lumbar or sacral by transperitoneal or retroperitoneal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2125.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21630","name":"Radical resection sternum","description":"Radical resection of sternum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73030","name":"X-ray exam of shoulder","description":"Radiologic examination, shoulder; complete, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33249","name":"Insj/rplcmt defib w/lead(s)","description":"Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82746","name":"Assay of folic acid serum","description":"Folic acid; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7005","name":"Nondisposable nebulizer set","description":"Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0294","name":"Hosp bed semi-elect w/ mattr","description":"Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1240","name":"Lumbar derotation pad","description":"Addition to tlso, (low profile), lumbar derotation pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2211","name":"Pneumatic propulsion tire","description":"Manual wheelchair accessory, pneumatic propulsion tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75571","name":"Ct hrt w/o dye w/ca test","description":"Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27647","name":"Resect talus/calcaneus tum","description":"Radical resection of tumor; talus or calcaneus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15821","name":"Blepharp lwr eyelid fat pad","description":"Blepharoplasty, lower eyelid; with extensive herniated fat pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8685","name":"Implt nrostm pls gen sng rec","description":"Implantable neurostimulator pulse generator, single array, rechargeable, includes extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2118","name":"Lens aniseikonic single","description":"Aniseikonic lens, single vision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64494","name":"Inj paravert f jnt l/s 2 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), lumbar or sacral; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20600","name":"Drain/inj joint/bursa w/o us","description":"Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31577","name":"Largsc w/rmvl foreign bdy(s)","description":"Laryngoscopy, flexible; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65155","name":"Reinsert ocular implant","description":"Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93610","name":"Intra-atrial pacing","description":"Intra-atrial pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00812","name":"Anes lwr intst scr colsc","description":"Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33120","name":"Exc icar tum resc w/card byp","description":"Excision of intracardiac tumor, resection with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43220","name":"Esophagoscopy balloon <30mm","description":"Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":781.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0574","name":"Ultrasonic generator w svneb","description":"Ultrasonic/electronic aerosol generator with small volume nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27635","name":"Remove lower leg bone lesion","description":"Excision or curettage of bone cyst or benign tumor, tibia or fibula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":484.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36578","name":"Replace tunneled cv cath","description":"Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19291","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S0199","name":"Med abortion inc all ex drug","description":"Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17315","name":"Mohs surg addl block","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92980","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":771.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78707","name":"K flow/funct image w/o drug","description":"Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34813","name":"Femoral endovas graft add-on","description":"Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25031","name":"I&d forearm&/wrist bursa","description":"Incision and drainage, forearm and/or wrist; bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L7272","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1104.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87910","name":"Nfct agt gntyp alys cmv","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); cytomegalovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0851","name":"Pwc gp 3 hd cap chair","description":"Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95940","name":"Ionm in operatng room 15 min","description":"Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11951","name":"Subq njx fil matrl 1.1-5.0cc","description":"Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32661","name":"Thoracoscopy w/pericard exc","description":"Thoracoscopy, surgical; with excision of pericardial cyst, tumor, or mass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":636.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52402","name":"Cysto trurl rescj ejacul dux","description":"Cystourethroscopy with transurethral resection or incision of ejaculatory ducts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85421","name":"Fibrinolytic plasminogen","description":"Fibrinolytic factors and inhibitors; plasminogen, antigenic assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92283","name":"Extnd color vision xm","description":"Color vision examination, extended, eg, anomaloscope or equivalent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26765","name":"Treat finger fracture each","description":"Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":417.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99446","name":"Ntrprof ph1/ntrnet/ehr 5-10","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patients treating/requesting physician or other qualified health care profess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20696","name":"App mltpln uni xtrnl fix 1st","description":"Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83582","name":"Assay of ketogenic steroids","description":"Ketogenic steroids, fractionation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27395","name":"Lengthening of thigh tendons","description":"Lengthening of hamstring tendon; multiple tendons, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6231","name":"Hydrogel dsg<=16 sq in","description":"Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0076","name":"Care manag h vst new pt 20 m","description":"Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00211","name":"Anes icr px crnec/crnot hmtm","description":"Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0274","name":"Over-bed table","description":"Over-bed table","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58660","name":"Laparoscopy lysis","description":"Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6550","name":"Neg pres wound ther drsg set","description":"Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59620","name":"Attempted vbac delivery only","description":"Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":849.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0740","name":"Non-implant pelv flr e-stim","description":"Non-implanted pelvic floor electrical stimulator, complete system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0422","name":"Intens cardiac rehab w/exerc","description":"Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73562","name":"X-ray exam of knee 3","description":"Radiologic examination, knee; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77071","name":"Mnl appl strs jt radiography","description":"Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87487","name":"Chlmyd pneum dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia pneumoniae, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88314","name":"Histochemical stains add-on","description":"Special stain including interpretation and report; histochemical stain on frozen tissue block (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51785","name":"Anal/urinary muscle study","description":"Needle electromyography studies (emg) of anal or urethral sphincter, any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96360","name":"Hydration iv infusion init","description":"Intravenous infusion, hydration; initial, 31 minutes to 1 hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1758","name":"Catheter, ureteral","description":"Catheter, ureteral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27758","name":"Treatment of tibia fracture","description":"Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93925","name":"Lower extremity study","description":"Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21810","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2508","name":"Sgd spelling phys contact","description":"Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87563","name":"M. genitalium amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycoplasma genitalium, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33208","name":"Insrt heart pm atrial & vent","description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0424","name":"Stationary compressed gas 02","description":"Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92371","name":"Rpr&refit spct prsth aphakia","description":"Repair and refitting spectacles; spectacle prosthesis for aphakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21255","name":"Reconstruct lower jaw bone","description":"Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1093.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77610","name":"Hyperthermia ntrstl prb 5/<","description":"Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37180","name":"Revision of circulation","description":"Venous anastomosis, open; splenorenal, proximal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1872.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28300","name":"Incision of heel bone","description":"Osteotomy; calcaneus (eg, dwyer or chambers type procedure), with or without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35304","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1123.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52355","name":"Cystouretero w/excise tumor","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of ureteral or renal pelvic tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99379","name":"Nursing fac care supervision","description":"Supervision of a nursing facility patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, comm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95065","name":"Dir nsl mucous membrane test","description":"Direct nasal mucous membrane test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73090","name":"X-ray exam of forearm","description":"Radiologic examination; forearm, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1811","name":"Sps/pass knee device","description":"Static progressive stretch/patient actualized serial stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15301","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12042","name":"Intmd rpr n-hf/genit2.6-7.5","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15731","name":"Forehead flap w/vasc pedicle","description":"Forehead flap with preservation of vascular pedicle (eg, axial pattern flap, paramedian forehead flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30630","name":"Repair nasal septum defect","description":"Repair nasal septal perforations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20703","name":"Rmvl imed rx delivery device","description":"Removal of drug-delivery device(s), intramedullary (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33477","name":"Implant tcat pulm vlv perq","description":"Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1181.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93924","name":"Lwr xtr vasc stdy bilat","description":"Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional doppler waveform or volume plethysmography recording and analysis at rest with ankle/brachial indices immediately after and at timed intervals following performance of a st","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49215","name":"Excise sacral spine tumor","description":"Excision of presacral or sacrococcygeal tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1824.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24145","name":"Prtl exc bone radial h/n","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87482","name":"Candida dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); candida species, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28192","name":"Removal of foot foreign body","description":"Removal of foreign body, foot; deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6196","name":"Alginate dressing <=16 sq in","description":"Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62164","name":"Remove brain tumor w/scope","description":"Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1911.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23430","name":"Repair biceps tendon","description":"Tenodesis of long tendon of biceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27514","name":"Treatment of thigh fracture","description":"Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":820.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0261","name":"Hosp bed semi-electr w/o mat","description":"Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93660","name":"Tilt table evaluation","description":"Evaluation of cardiovascular function with tilt table evaluation, with continuous ecg monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0838","name":"Pwc gp 2 hd sing pow opt cap","description":"Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0493","name":"Emr pwr cbl combo vad, rep","description":"Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27562","name":"Treat kneecap dislocation","description":"Closed treatment of patellar dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72083","name":"X-ray exam entire spi 4/5 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 4 or 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77615","name":"Hyperthermia ntrstl prb>5","description":"Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":857.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3913","name":"Hfo w/o joints cf","description":"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43341","name":"Fuse esophagus & intestine","description":"Esophagojejunostomy (without total gastrectomy); thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97172","name":"Athletic trn re-eval plan cr","description":"Re-evaluation of athletic training established plan of care requiring these components: an assessment of patients current functional status when there is a documented change; and a revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77065","name":"Dx mammo incl cad uni","description":"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93572","name":"Iv dop vel&/press c flo ea","description":"Intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, when performed; each additional vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27509","name":"Treatment of thigh fracture","description":"Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4207","name":"2 cc sterile syringe&needle","description":"Syringe with needle, sterile 2 cc, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76706","name":"Us abdl aorta screen aaa","description":"Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (aaa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25263","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29086","name":"Application cast finger","description":"Application, cast; finger (eg, contracture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99439","name":"Chrnc care mgmt staf ea addl","description":"Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or funct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58571","name":"Tlh w/t/o 250 g or less","description":"Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":573.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88261","name":"Chromosome analysis 5","description":"Chromosome analysis; count 5 cells, 1 karyotype, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81003","name":"Urinalysis auto w/o scope","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, without microscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84510","name":"Assay of tyrosine","description":"Tyrosine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33992","name":"Rmvl perq left heart vad","description":"Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), at separate and distinct session from insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68550","name":"Remove tear gland lesion","description":"Excision of lacrimal gland tumor; involving osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":708.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33207","name":"Insert heart pm ventricular","description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":414.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99417","name":"Prolng op e/m each 15 min","description":"Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (list separately in addition to the code of the outpa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80185","name":"Assay of phenytoin total","description":"Phenytoin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76102","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0245","name":"Initial foot exam pt lops","description":"Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90951","name":"Esrd serv 4 visits p mo <2yr","description":"End-stage renal disease (esrd) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care pro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":662.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43848","name":"Revj open gstr rstcv px","description":"Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0841","name":"Pwc gp2 std mult pow opt s/b","description":"Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0955","name":"Cushioned headrest","description":"Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95870","name":"Ndl emg lmtd std musc 1 xtr","description":"Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99394","name":"Prev visit est age 12-17","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32604","name":"Thoracoscopy wbx sac","description":"Thoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42200","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate, soft and/or hard palate only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75887","name":"Vein x-ray liver w/o hemodyn","description":"Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7036","name":"Pos airway press chinstrap","description":"Chinstrap used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32851","name":"Lung transplant single","description":"Lung transplant, single; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86386","name":"Nuclear matrix protein 22","description":"Nuclear matrix protein 22 (nmp22), qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0563T","name":"Evac meibomian glnd heat bi","description":"Evacuation of meibomian glands, using heat delivered through wearable, open-eye eyelid treatment devices and manual gland expression, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0668","name":"Seg pneumatic appl full arm","description":"Segmental pneumatic appliance for use with pneumatic compressor, full arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15823","name":"Blepharp upr eyelid xcsv skn","description":"Blepharoplasty, upper eyelid; with excessive skin weighting down lid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27246","name":"Treat thigh fracture","description":"Closed treatment of greater trochanteric fracture, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":325.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37243","name":"Vasc embolize/occlude organ","description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4783.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0484T","name":"Tmvi transthoracic exposure","description":"Transcatheter mitral valve implantation/replacement (tmvi) with prosthetic valve; transthoracic exposure (eg, thoracotomy, transapical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93544","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6650","name":"Shoulder universal joint","description":"Upper extremity addition, shoulder universal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92315","name":"C-lens fitg tech aphakia 1","description":"Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, 1 eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73564","name":"X-ray exam knee 4 or more","description":"Radiologic examination, knee; complete, 4 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92273","name":"Full field erg w/i&r","description":"Electroretinography (erg), with interpretation and report; full field (ie, fferg, flash erg, ganzfeld erg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85018","name":"Hemoglobin","description":"Blood count; hemoglobin (hgb)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86617","name":"Lyme disease antibody","description":"Antibody; borrelia burgdorferi (lyme disease) confirmatory test (eg, western blot or immunoblot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47100","name":"Wedge biopsy of liver","description":"Biopsy of liver, wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":702.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72127","name":"Ct neck spine w/o & w/dye","description":"Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34820","name":"Opn iliac art expos","description":"Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88233","name":"Tissue culture skin/biopsy","description":"Tissue culture for non-neoplastic disorders; skin or other solid tissue biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95834","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53446","name":"Remove uro sphincter","description":"Removal of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":519.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63012","name":"Remove lamina/facets lumbar","description":"Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (gill type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0290","name":"Hosp bed fx ht w/o rails w/m","description":"Hospital bed, fixed height, without side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64446","name":"Njx aa&/strd sc nrv nfs img","description":"Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38213","name":"Platelet deplete of harvest","description":"Transplant preparation of hematopoietic progenitor cells; platelet depletion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20975","name":"Estim aid bone healg invasiv","description":"Electrical stimulation to aid bone healing; invasive (operative)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00144","name":"Anes px eye corneal trnspl","description":"Anesthesia for procedures on eye; corneal transplant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0316","name":"Bed safety enclosure","description":"Safety enclosure frame/canopy for use with hospital bed, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5985","name":"Lwr ext dynamic prosth pylon","description":"All endoskeletal lower extremity prostheses, dynamic prosthetic pylon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76811","name":"Ob us detailed sngl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0280","name":"Bed cradle","description":"Bed cradle, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54235","name":"Njx corpora cavernosa rx agt","description":"Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99360","name":"Physician standby services","description":"Standby service, requiring prolonged attendance, each 30 minutes (eg, operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring eeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64822","name":"Sympathectomy ulnar artery","description":"Sympathectomy; ulnar artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4416","name":"Ost pch clsd w barrier/filtr","description":"Ostomy pouch, closed, with barrier attached, with filter (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5692","name":"Ak pelvic control belt light","description":"Addition to lower extremity, above knee, pelvic control belt, light","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67875","name":"Closure of eyelid by suture","description":"Temporary closure of eyelids by suture (eg, frost suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91117","name":"Colon motility 6 hr study","description":"Colon motility (manometric) study, minimum 6 hours continuous recording (including provocation tests, eg, meal, intracolonic balloon distension, pharmacologic agents, if performed), with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93930","name":"Upper extremity study","description":"Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0311","name":"Immunize counsel 16-30 mins","description":"Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service,  16-30 mins time (this code is used for medicaid billing purposes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60254","name":"Extensive thyroid surgery","description":"Thyroidectomy, total or subtotal for malignancy; with radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1404.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86580","name":"Tb intradermal test","description":"Skin test; tuberculosis, intradermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43118","name":"Partial removal of esophagus","description":"Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5450","name":"Postop app non-wgt bear dsg","description":"Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51565","name":"Revise bladder & ureter(s)","description":"Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1060.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0001","name":"Alcohol and/or drug assess","description":"Alcohol and/or drug assessment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82731","name":"Assay of fetal fibronectin","description":"Fetal fibronectin, cervicovaginal secretions, semi-quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44145","name":"Partial removal of colon","description":"Colectomy, partial; with coloproctostomy (low pelvic anastomosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43271","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":329.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93313","name":"Echo transesophageal","description":"Echocardiography, transesophageal, real-time with image documentation (2d) (with or without m-mode recording); placement of transesophageal probe only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97026","name":"Infrared therapy","description":"Application of a modality to 1 or more areas; infrared","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40761","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (abbe-estlander type), including sectioning and inserting of pedicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87274","name":"Herpes simplex 1 ag if","description":"Infectious agent antigen detection by immunofluorescent technique; herpes simplex virus type 1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27216","name":"Treat pelvic ring fracture","description":"Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral (includes ipsilateral ilium, sacroiliac joint and/or sacrum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33840","name":"Exc coa w/direct anastomosis","description":"Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1072.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57425","name":"Laparoscopy surg colpopexy","description":"Laparoscopy, surgical, colpopexy (suspension of vaginal apex)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0447","name":"Behavior counsel obesity 15m","description":"Face-to-face behavioral counseling for obesity, 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50437","name":"Dilat xst trc new access rcs","description":"Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed; including new access into the renal collecting sys","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91013","name":"Esophgl motil w/stim/perfus","description":"Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion (eg, stimulant, acid or alkali perfusion) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1600","name":"Ho flex frejka w/cov pre cst","description":"Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27177","name":"Treat slipped epiphysis","description":"Open treatment of slipped femoral epiphysis; single or multiple pinning or bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95970","name":"Alys npgt w/o prgrmg","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69745","name":"Repair facial nerve","description":"Suture facial nerve, intratemporal, with or without graft or decompression; including medial to geniculate ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1002.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62117","name":"Reduction of skull defect","description":"Reduction of craniomegalic skull (eg, treated hydrocephalus); requiring craniotomy and reconstruction with or without bone graft (includes obtaining grafts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47490","name":"Incision of gallbladder","description":"Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4315","name":"Cath w/drainage 2-way silcne","description":"Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12054","name":"Intmd rpr face/mm 7.6-12.5cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93880","name":"Extracranial bilat study","description":"Duplex scan of extracranial arteries; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4210","name":"Orth dev repair/repl minor p","description":"Repair of orthotic device, repair or replace minor parts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43881","name":"Impl/rplcmt gstr nstim eltrd","description":"Implantation or replacement of gastric neurostimulator electrodes, antrum, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0043","name":"Ftrst lowr exten tube rep ea","description":"Footrest, lower extension tube, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50660","name":"Removal of ureter","description":"Ureterectomy, total, ectopic ureter, combination abdominal, vaginal and/or perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":924.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31032","name":"Explore sinus remove polyps","description":"Sinusotomy, maxillary (antrotomy); radical (caldwell-luc) with removal of antrochoanal polyps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":431.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0108","name":"Diab manage trn  per indiv","description":"Diabetes outpatient self-management training services, individual, per 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33610","name":"Repair by enlargement","description":"Repair of complex cardiac anomalies (eg, single ventricle with subaortic obstruction) by surgical enlargement of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1540.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22319","name":"Treat odontoid fx w/graft","description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1663.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2230","name":"Split flat caliper stirr & p","description":"Addition to lower extremity, split flat caliper stirrups and plate attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77470","name":"Special radiation treatment","description":"Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral or endocavitary irradiation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43640","name":"Vagotomy & pylorus repair","description":"Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selective","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":982.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63251","name":"Revise spinal cord vsls thrc","description":"Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74261","name":"Ct colonography dx","description":"Computed tomographic (ct) colonography, diagnostic, including image postprocessing; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31290","name":"Nasal/sinus endoscopy surg","description":"Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid region","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":860.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78434","name":"Aqmbf pet rest & rx stress","description":"Absolute quantitation of myocardial blood flow (aqmbf), positron emission tomography (pet), rest and pharmacologic stress (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65756","name":"Corneal trnspl endothelial","description":"Keratoplasty (corneal transplant); endothelial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25830","name":"Arthrd dst rad/ul jt sgm rsc","description":"Arthrodesis, distal radioulnar joint with segmental resection of ulna, with or without bone graft (eg, sauve-kapandji procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80432","name":"Insulin suppression panel","description":"Insulin-induced c-peptide suppression panel this panel must include the following: insulin (83525) c-peptide (84681 x 5) glucose (82947 x 5)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54001","name":"Slitting of prepuce","description":"Slitting of prepuce, dorsal or lateral (separate procedure); except newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43117","name":"Partial removal of esophagus","description":"Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty (ivor lewis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2708.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5950","name":"Endo ak ultra-light material","description":"Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33406","name":"Replacement aortic valve opn","description":"Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27090","name":"Removal of hip prosthesis","description":"Removal of hip prosthesis; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76390","name":"Mr spectroscopy","description":"Magnetic resonance spectroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26531","name":"Revise knuckle with implant","description":"Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":523.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35683","name":"Composite byp grft 3/> segmt","description":"Bypass graft; autogenous composite, 3 or more segments of vein from 2 or more locations (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31775","name":"Reconstruct bronchus","description":"Bronchoplasty; excision stenosis and anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68400","name":"I&d lacrimal gland","description":"Incision, drainage of lacrimal gland","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15732","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":783.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33851","name":"Exc coa rpr l subcl art/prst","description":"Excision of coarctation of aorta, with or without associated patent ductus arteriosus; repair using either left subclavian artery or prosthetic material as gusset for enlargement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20005","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":252.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24685","name":"Optx ulnar fx prox end w/fix","description":"Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":548.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00222","name":"Anes icr px ecoag icr nrv","description":"Anesthesia for intracranial procedures; electrocoagulation of intracranial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61692","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; dural, complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3392.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4755","name":"Comb art/venous blood tubing","description":"Blood tubing, arterial and venous combined, for hemodialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26485","name":"Transplant palm tendon","description":"Transfer or transplant of tendon, palmar; without free tendon graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":676.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01638","name":"Anes opn/arthr tot sho rplcm","description":"Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5724","name":"Knee-shin exo fluid swing ph","description":"Addition, exoskeletal knee-shin system, single axis, fluid swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":933.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23184","name":"Prtl excision bone prox hum","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), proximal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4217","name":"Sterile water/saline, 500 ml","description":"Sterile water/saline, 500 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82397","name":"Chemiluminescent assay","description":"Chemiluminescent assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25355","name":"Revision of radius","description":"Osteotomy, radius; middle or proximal third","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57110","name":"Vagnc compl rmvl vag wall","description":"Vaginectomy, complete removal of vaginal wall;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2760","name":"Extension per extension per","description":"Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83721","name":"Assay of blood lipoprotein","description":"Lipoprotein, direct measurement; ldl cholesterol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2108","name":"Spherocylinder 4.25d/2.12-4d","description":"Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87491","name":"Chlmyd trach dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia trachomatis, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4327","name":"Fem urinary collect dev cup","description":"Female external urinary collection device; meatal cup, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54410","name":"Remove/replace penis prosth","description":"Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11971","name":"Rmvl tis xpndr wo insj implt","description":"Removal of tissue expander without insertion of implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":304.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33406","name":"Replacement aortic valve opn","description":"Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2509.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43820","name":"Gastrojejunostomy wo vagotmy","description":"Gastrojejunostomy; without vagotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1123.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P7001","name":"Culture bacterial urine","description":"Culture, bacterial, urine; quantitative, sensitivity study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5700","name":"Replace socket below knee","description":"Replacement, socket, below knee, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1384.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63267","name":"Excise intrspinl lesion lmbr","description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1227.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15839","name":"Exc excessive skn other area","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58210","name":"Extensive hysterectomy","description":"Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95716","name":"Veeg ea 12-26hr cont mntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80051","name":"Electrolyte panel","description":"Electrolyte panel this panel must include the following: carbon dioxide (bicarbonate) (82374) chloride (82435) potassium (84132) sodium (84295)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92004","name":"Compre oph exam new pt 1/>","description":"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0738","name":"Portable gas oxygen system","description":"Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5618","name":"Test socket symes","description":"Addition to lower extremity, test socket, symes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90826","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0886","name":"Pwc gp4 hd mult pow s/b","description":"Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27696","name":"Repair of ankle ligaments","description":"Repair, primary, disrupted ligament, ankle; both collateral ligaments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57240","name":"Anterior colporrhaphy","description":"Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystourethroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","name":"Comprehen metabolic panel","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) potassium (84132) protein, total (84155) sodium ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83037","name":"Hb glycosylated a1c home dev","description":"Hemoglobin; glycosylated (a1c) by device cleared by fda for home use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87168","name":"Macroscopic exam arthropod","description":"Macroscopic examination; arthropod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92002","name":"Intrm oph exam new patient","description":"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28296","name":"Cor hlx vlgs dstl mtar osteo","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":734.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96105","name":"Assessment of aphasia","description":"Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by boston diagnostic aphasia examination) with interpretation and report, per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64600","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26608","name":"Treat metacarpal fracture","description":"Percutaneous skeletal fixation of metacarpal fracture, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28312","name":"Revision of toe","description":"Osteotomy, shortening, angular or rotational correction; other phalanges, any toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0208T","name":"Audiometry air only","description":"Pure tone audiometry (threshold), automated; air only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8420","name":"Prosthetic sock multi ply bk","description":"Prosthetic sock, multiple ply, below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0462","name":"Rocking bed w/ or w/o side r","description":"Rocking bed with or without side rails","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82693","name":"Assay of ethylene glycol","description":"Ethylene glycol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76828","name":"Echo exam of fetal heart","description":"Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7000","name":"Disposable canister for pump","description":"Canister, disposable, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86185","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61783","name":"Scan proc spinal","description":"Stereotactic computer-assisted (navigational) procedure; spinal (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62115","name":"Reduction of skull defect","description":"Reduction of craniomegalic skull (eg, treated hydrocephalus); not requiring bone grafts or cranioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62365","name":"Remove spine infusion device","description":"Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5420","name":"Postop dsg & 1 cast chg ak/d","description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change ak or knee disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26390","name":"Revise hand/finger tendon","description":"Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77338","name":"Design mlc device for imrt","description":"Multi-leaf collimator (mlc) device(s) for intensity modulated radiation therapy (imrt), design and construction per imrt plan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27258","name":"Treat hip dislocation","description":"Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":940.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87103","name":"Blood fungus culture","description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95954","name":"Eeg monitoring/giving drugs","description":"Pharmacological or physical activation requiring physician or other qualified health care professional attendance during eeg recording of activation phase (eg, thiopental activation test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73201","name":"Ct upper extremity w/dye","description":"Computed tomography, upper extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35495","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":540.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77053","name":"X-ray of mammary duct","description":"Mammary ductogram or galactogram, single duct, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78457","name":"Venous thrombosis imaging","description":"Venous thrombosis imaging, venogram; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80150","name":"Assay of amikacin","description":"Amikacin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0328","name":"Fecal blood scrn immunoassay","description":"Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35311","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; subclavian, innominate, by thoracic incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1353.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57230","name":"Repair of urethral lesion","description":"Plastic repair of urethrocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":261.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21193","name":"Reconst lwr jaw w/o graft","description":"Reconstruction of mandibular rami, horizontal, vertical, c, or l osteotomy; without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74775","name":"X-ray exam of perineum","description":"Perineogram (eg, vaginogram, for sex determination or extent of anomalies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20663","name":"Application halo femoral","description":"Application of halo, including removal; femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32151","name":"Remove lung foreign body","description":"Thoracotomy; with removal of intrapulmonary foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54352","name":"Revj prior hypspad repair","description":"Revision of prior hypospadias repair requiring extensive dissection and excision of previously constructed structures including re-release of chordee and reconstruction of urethra and penis by use of local skin as grafts and island flaps and skin brought in as flaps or grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54065","name":"Destruction penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21344","name":"Open tx compl front sinus fx","description":"Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4164","name":"Parenteral 50% dextrose solu","description":"Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33608","name":"Repair anomaly w/conduit","description":"Repair of complex cardiac anomaly other than pulmonary atresia with ventricular septal defect by construction or replacement of conduit from right or left ventricle to pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29875","name":"Arthrs knee surg synvct lmtd","description":"Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":417.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20930","name":"Sp bone algrft morsel add-on","description":"Allograft, morselized, or placement of osteopromotive material, for spine surgery only (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78110","name":"Plasma volume single","description":"Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3929","name":"Hfo nontorsion jnts pre cst","description":"Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61340","name":"Subtemporal cranial dcmprn","description":"Subtemporal cranial decompression (pseudotumor cerebri, slit ventricle syndrome)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64569","name":"Revise/repl vagus n eltrd","description":"Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1100","name":"Whchr s-recl fxd arm leg res","description":"Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32856","name":"Prepare donor lung double","description":"Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44180","name":"Lap enterolysis","description":"Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":765.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47800","name":"Reconstruction of bile ducts","description":"Reconstruction, plastic, of extrahepatic biliary ducts with end-to-end anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1315.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0482","name":"Cough stimulating device","description":"Cough stimulating device, alternating positive and negative airway pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51798","name":"Us urine capacity measure","description":"Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88300","name":"Surgical path gross","description":"Level i - surgical pathology, gross examination only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60260","name":"Repeat thyroid surgery","description":"Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7041","name":"Water seal drain container","description":"Water seal drainage container and tubing for use with implanted chest tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01340","name":"Anes clsd px lower 1/3 femur","description":"Anesthesia for all closed procedures on lower one-third of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22015","name":"I&d abscess p-spine l/s/ls","description":"Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbosacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37197","name":"Remove intrvas foreign body","description":"Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00172","name":"Anes ntroral px rpr clft pal","description":"Anesthesia for intraoral procedures, including biopsy; repair of cleft palate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86826","name":"Hla x-match noncytotoxc addl","description":"Human leukocyte antigen (hla) crossmatch, non-cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41108","name":"Biopsy of floor of mouth","description":"Biopsy of floor of mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36405","name":"Vnpnxr<3yrs phy/qhp scalp vn","description":"Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; scalp vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68110","name":"Exc les conjunctiva <1 cm","description":"Excision of lesion, conjunctiva; up to 1 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0747","name":"Elec osteogen stim not spine","description":"Osteogenesis stimulator, electrical, non-invasive, other than spinal applications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67414","name":"Explr/decompress eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":845.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19302","name":"P-mastectomy w/ln removal","description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":604.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51040","name":"Incise & drain bladder","description":"Cystostomy, cystotomy with drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87491","name":"Chlmyd trach dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia trachomatis, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67882","name":"Revision of eyelid","description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62258","name":"Replace brain cavity shunt","description":"Removal of complete cerebrospinal fluid shunt system; with replacement by similar or other shunt at same operation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1003.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31717","name":"Bronchial brush biopsy","description":"Catheterization with bronchial brush biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61860","name":"Implant neuroelectrodes","description":"Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36582","name":"Replace tunneled cv cath","description":"Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":807.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83002","name":"Assay of gonadotropin (lh)","description":"Gonadotropin; luteinizing hormone (lh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35002","name":"Repair artery rupture neck","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, carotid, subclavian artery, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99449","name":"Ntrprof ph1/ntrnet/ehr 31/>","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patients treating/requesting physician or other qualified health care profess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73020","name":"X-ray exam of shoulder","description":"Radiologic examination, shoulder; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35523","name":"Art byp grft brchl-ulnr-rdl","description":"Bypass graft, with vein; brachial-ulnar or -radial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49040","name":"Drain open abdom abscess","description":"Drainage of subdiaphragmatic or subphrenic abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24147","name":"Prtl exc bone olecrn process","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), olecranon process","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":523.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40530","name":"Partial removal of lip","description":"Resection of lip, more than one-fourth, without reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28445","name":"Optx talus fracture","description":"Open treatment of talus fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":861.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32561","name":"Lyse chest fibrin init day","description":"Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); initial day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1652","name":"Ho bi thighcuffs w sprdr bar","description":"Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8505","name":"Artificial larynx, accessory","description":"Artificial larynx replacement battery / accessory, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26535","name":"Revise finger joint","description":"Arthroplasty, interphalangeal joint; each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93600","name":"Bundle of his recording","description":"Bundle of his recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3760","name":"Eo adj jt prefab custom fit","description":"Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific  patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42000","name":"Drainage mouth roof lesion","description":"Drainage of abscess of palate, uvula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11770","name":"Exc pilonidal cyst simple","description":"Excision of pilonidal cyst or sinus; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86325","name":"Other immunoelectrophoresis","description":"Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0623","name":"Sio rig pnl pelv/sac pre ots","description":"Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0236T","name":"Trluml perip athrc abd aorta","description":"Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; abdominal aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9507.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65772","name":"Correction of astigmatism","description":"Corneal relaxing incision for correction of surgically induced astigmatism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0147","name":"Walker variable wheel resist","description":"Walker, heavy duty, multiple braking system, variable wheel resistance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0268","name":"Removal of impacted wax md","description":"Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29515","name":"Application short leg splint","description":"Application of short leg splint (calf to foot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5121","name":"Solid skin barrier 6x6","description":"Skin barrier; solid, 6 x 6 or equivalent, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88367","name":"Insitu hybridization auto","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36620","name":"Insertion catheter artery","description":"Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28200","name":"Repair of foot tendon","description":"Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15824","name":"Rhytidectomy forehead","description":"Rhytidectomy; forehead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1630","name":"Abduct control hip semi-flex","description":"Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4673","name":"Ext line w easy lock connect","description":"Extension line with easy lock connectors, used with dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8500","name":"Artificial larynx","description":"Artificial larynx, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0427","name":"Inpt/ed teleconsult70","description":"Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90969","name":"Esrd svc pr day pt 12-19","description":"End-stage renal disease (esrd) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41007","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":256.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46607","name":"Diagnostic anoscopy & biopsy","description":"Anoscopy; with high-resolution magnification (hra) (eg, colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59400","name":"Obstetrical care","description":"Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1854.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55725","name":"Drainage of prostate abscess","description":"Prostatotomy, external drainage of prostatic abscess, any approach; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":480.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28435","name":"Cltx talus fracture w/mnpj","description":"Closed treatment of talus fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63268","name":"Excise intrspinl lesion scrl","description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1272.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85380","name":"Fibrin degradj d-dimer","description":"Fibrin degradation products, d-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23480","name":"Revision of collar bone","description":"Osteotomy, clavicle, with or without internal fixation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":693.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4300","name":"Cath impl vasc access portal","description":"Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74415","name":"Urography nfs drip&/bls w/nf","description":"Urography, infusion, drip technique and/or bolus technique; with nephrotomography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23675","name":"Cltx sho dislc neck fx mnpj","description":"Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":463.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25260","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66840","name":"Removal of lens material","description":"Removal of lens material; aspiration technique, 1 or more stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":416.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26210","name":"Removal of finger lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":369.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75893","name":"Venous sampling by catheter","description":"Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96366","name":"Ther/proph/diag iv inf addon","description":"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28515","name":"Treatment of toe fracture","description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22842","name":"Insert spine fixation device","description":"Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":683.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73620","name":"X-ray exam of foot","description":"Radiologic examination, foot; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89220","name":"Sputum specimen collection","description":"Sputum, obtaining specimen, aerosol induced technique (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93456","name":"R hrt coronary artery angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38505","name":"Needle biopsy lymph nodes","description":"Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20934","name":"Intercalary algrft compl","description":"Allograft, includes templating, cutting, placement and internal fixation, when performed; intercalary, complete (ie, cylindrical) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82943","name":"Assay of glucagon","description":"Glucagon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92626","name":"Eval aud funcj 1st hour","description":"Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22520","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1766.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61770","name":"Incise skull for treatment","description":"Stereotactic localization, including burr hole(s), with insertion of catheter(s) or probe(s) for placement of radiation source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64708","name":"Revise arm/leg nerve","description":"Neuroplasty, major peripheral nerve, arm or leg, open; other than specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69806","name":"Explore inner ear","description":"Endolymphatic sac operation; with shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":752.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99409","name":"Audit/dast over 30 min","description":"Alcohol and/or substance (other than tobacco) abuse structured screening (eg, audit, dast), and brief intervention (sbi) services; greater than 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1620","name":"Ho flex pavlik harns pre cst","description":"Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83036","name":"Hemoglobin glycosylated a1c","description":"Hemoglobin; glycosylated (a1c)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97167","name":"Ot eval high complex 60 min","description":"Occupational therapy evaluation, high complexity, requiring these components: an occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88184","name":"Flowcytometry/ tc 1 marker","description":"Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2087","name":"Off base opioid tx, 60 m","description":"Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6648","name":"Ext pwrd shlder lock/unlock","description":"Upper extremity addition, shoulder lock mechanism, external powered actuator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99306","name":"1st nf care high mdm 50","description":"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 50 minutes must be met or exceed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29826","name":"Sho arthrs srg decompression","description":"Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2388","name":"Foam drive wheel tire","description":"Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0076","name":"Care manag h vst new pt 20 m","description":"Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41010","name":"Incision of tongue fold","description":"Incision of lingual frenum (frenotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5643","name":"Hip flex inner socket ext fr","description":"Addition to lower extremity, hip disarticulation, flexible inner socket, external frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87275","name":"Influenza b ag if","description":"Infectious agent antigen detection by immunofluorescent technique; influenza b virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2650","name":"Pelv & thor control gluteal","description":"Addition to lower extremity, pelvic and thoracic control, gluteal pad, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38120","name":"Laparoscopy splenectomy","description":"Laparoscopy, surgical, splenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4377","name":"Drainable plstic pch w/o fp","description":"Ostomy pouch, drainable, for use on faceplate, plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5668","name":"Bk molded distal cushion","description":"Addition  to lower extremity, below knee, molded distal cushion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5266","name":"Battery for hearing device","description":"Battery for use in hearing device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0863","name":"Pwc gp3 vhd mult pow opt s/b","description":"Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32554","name":"Aspirate pleura w/o imaging","description":"Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24900","name":"Amputation of upper arm","description":"Amputation, arm through humerus; with primary closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":622.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76705","name":"Echo exam of abdomen","description":"Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4750","name":"Art or venous blood tubing","description":"Blood tubing, arterial or venous, for hemodialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77081","name":"Dxa bone density appendiculr","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88741","name":"Transcutaneous methb","description":"Hemoglobin, quantitative, transcutaneous, per day; methemoglobin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86376","name":"Microsomal antibody each","description":"Microsomal antibodies (eg, thyroid or liver-kidney), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92552","name":"Pure tone audiometry air","description":"Pure tone audiometry (threshold); air only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31086","name":"Removal of frontal sinus","description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, brow incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47550","name":"Bile duct endoscopy add-on","description":"Biliary endoscopy, intraoperative (choledochoscopy) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83701","name":"Lipoprotein bld hr fraction","description":"Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7191","name":"Elbow child myoelectronic ct","description":"Electronic elbow, child, variety village or equal, myoelectronically controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24134","name":"Sequestrectomy shft/dstl hum","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4521","name":"Adult size brief/diaper sm","description":"Adult sized disposable incontinence product, brief/diaper, small, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50693","name":"Plmt ureteral stent prq","description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":838.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51820","name":"Revision of urinary tract","description":"Cystourethroplasty with unilateral or bilateral ureteroneocystostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27703","name":"Reconstruction ankle joint","description":"Arthroplasty, ankle; revision, total ankle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":936.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44394","name":"Colonoscopy w/snare","description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86830","name":"Hla class i phenotype qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); antibody identification by qualitative panel using complete hla phenotypes, hla class i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19330","name":"Rmvl ruptured breast implant","description":"Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86671","name":"Fungus nes antibody","description":"Antibody; fungus, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21046","name":"Remove mandible cyst complex","description":"Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":836.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67145","name":"Proph rta dtchmnt pc","description":"Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33254","name":"Ablate atria lmtd","description":"Operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22905","name":"Rad resect abd tumor 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1147.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14001","name":"Tis trnfr trunk 10.1-30sqcm","description":"Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75885","name":"Vein x-ray liver w/hemodynam","description":"Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7036","name":"Pos airway press chinstrap","description":"Chinstrap used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0671","name":"Pressure pneum appl full leg","description":"Segmental gradient pressure pneumatic appliance, full leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53440","name":"Male sling procedure","description":"Sling operation for correction of male urinary incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58345","name":"Reopen fallopian tube","description":"Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64680","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31237","name":"Nsl/sins ndsc surg bx polypc","description":"Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21179","name":"Rcnstj forehead with grafts","description":"Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45402","name":"Lap proctopexy w/sig resect","description":"Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89049","name":"Chct for mal hyperthermia","description":"Caffeine halothane contracture test (chct) for malignant hyperthermia susceptibility, including interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5613","name":"Ak 4 bar ling w/hydraul swig","description":"Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1216.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2201","name":"Lens sphere bifocal 4.12-7.0","description":"Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5210","name":"No knee/ankle joints w/ ft b","description":"Above knee, short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1605.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31770","name":"Repair/graft of bronchus","description":"Bronchoplasty; graft repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54401","name":"Insert self-contd prosthesis","description":"Insertion of penile prosthesis; inflatable (self-contained)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9037","name":"Plate pheres leukoredu irrad","description":"Platelets, pheresis, leukocytes reduced, irradiated, each unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82374","name":"Assay blood carbon dioxide","description":"Carbon dioxide (bicarbonate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4619","name":"Face tent","description":"Face tent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27756","name":"Treatment of tibia fracture","description":"Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins or screws)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43633","name":"Removal of stomach partial","description":"Gastrectomy, partial, distal; with roux-en-y reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57289","name":"Repair bladder & vagina","description":"Pereyra procedure, including anterior colporrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62161","name":"Dissect brain w/scope","description":"Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96416","name":"Chemo prolong infuse w/pump","description":"Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25109","name":"Excise tendon forearm/wrist","description":"Excision of tendon, forearm and/or wrist, flexor or extensor, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76815","name":"Ob us limited fetus(s)","description":"Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22804","name":"Arthrd pst dfrm 13+ vrt sgm","description":"Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2116.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93922","name":"Upr/l xtremity art 2 levels","description":"Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, doppler waveform recording and analysis at 1-2 levels, or ankle/brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58301","name":"Remove intrauterine device","description":"Removal of intrauterine device (iud)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86835","name":"Hla class ii semiquant panel","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); semi-quantitative panel (eg, titer), hla class ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31370","name":"Partial removal of larynx","description":"Partial laryngectomy (hemilaryngectomy); horizontal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51940","name":"Correction of bladder defect","description":"Closure, exstrophy of bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24331","name":"Flexor-plasty elbw w/advmnt","description":"Flexor-plasty, elbow (eg, steindler type advancement); with extensor advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93882","name":"Extracranial uni/ltd study","description":"Duplex scan of extracranial arteries; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87339","name":"H pylori ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; helicobacter pylori","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61585","name":"Orbitocranial approach/skull","description":"Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); with orbital exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2962.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64416","name":"Njx aa&/strd brch pl nfs img","description":"Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50815","name":"Urine shunt to intestine","description":"Ureterocolon conduit, including intestine anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99391","name":"Per pm reeval est pat infant","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26370","name":"Repair finger/hand tendon","description":"Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":634.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93784","name":"Ambl bp mntr w/software","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; including recording, scanning analysis, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92240","name":"Icg angiography i&r uni/bi","description":"Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6641","name":"Excursion amplifier pulley t","description":"Upper extremity addition, excursion amplifier, pulley type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11602","name":"Exc tr-ext mal+marg 1.1-2 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2303","name":"Lens sphcy trifocal 4.0/.12-","description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83992","name":"Assay for phencyclidine","description":"Phencyclidine (pcp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86304","name":"Immunoassay tumor ca 125","description":"Immunoassay for tumor antigen, quantitative; ca 125","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5960","name":"Endo hip ultra-light materia","description":"Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":635.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2312","name":"Mini-prop remote joystick","description":"Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27305","name":"Incise thigh tendon & fascia","description":"Fasciotomy, iliotibial (tenotomy), open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4154","name":"Ef spec metabolic noninherit","description":"Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65235","name":"Remove foreign body from eye","description":"Removal of foreign body, intraocular; from anterior chamber of eye or lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":432.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3919","name":"Ho w/o joints cf","description":"Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0731","name":"Conductive garment for tens/","description":"Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patients skin by layers of fabric)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45400","name":"Laparoscopic proc","description":"Laparoscopy, surgical; proctopexy (for prolapse)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":905.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72156","name":"Mri neck spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95970","name":"Alys npgt w/o prgrmg","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20955","name":"Fibula bone graft microvasc","description":"Bone graft with microvascular anastomosis; fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92520","name":"Laryngeal function studies","description":"Laryngeal function studies (ie, aerodynamic testing and acoustic testing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19364","name":"Brst rcnstj free flap","description":"Breast reconstruction; with free flap (eg, ftram, diep, siea, gap flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33257","name":"Ablate atria lmtd add-on","description":"Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24344","name":"Reconstruct elbow lat ligmnt","description":"Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":918.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82757","name":"Assay of semen fructose","description":"Fructose, semen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19295","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62200","name":"Establish brain cavity shunt","description":"Ventriculocisternostomy, third ventricle;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1256.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44180","name":"Lap enterolysis","description":"Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61107","name":"Tdh pnxr implt ventr cath","description":"Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for implanting ventricular catheter, pressure recording device, or other intracerebral monitoring device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1270","name":"Wheelchair lightweight leg r","description":"Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23540","name":"Cltx acromclav dislc wo mnpj","description":"Closed treatment of acromioclavicular dislocation; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2310","name":"Electro connect btw control","description":"Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22864","name":"Rmvl tot arthrp 1ntrspc crv","description":"Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1893.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73552","name":"X-ray exam of femur 2/>","description":"Radiologic examination, femur; minimum 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0205","name":"Heat lamp with stand","description":"Heat lamp, with stand, includes bulb, or infrared element","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2755","name":"Carbon graphite lamination","description":"Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76870","name":"Us exam scrotum","description":"Ultrasound, scrotum and contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0162","name":"Sitz bath chair","description":"Sitz bath chair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82668","name":"Assay of erythropoietin","description":"Erythropoietin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86486","name":"Skin test unlisted antign ea","description":"Skin test; unlisted antigen, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58960","name":"Exploration of abdomen","description":"Laparotomy, for staging or restaging of ovarian, tubal, or primary peritoneal malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aortic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":621.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10030","name":"Img gid flu coll drg sft tis","description":"Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5699","name":"Shoulder harness","description":"All lower extremity prostheses, shoulder harness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33973","name":"Insert balloon device","description":"Insertion of intra-aortic balloon assist device through the ascending aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":444.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21016","name":"Resect face/scalp tum 2 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; 2 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96932","name":"Rcm img acquisj only 1st les","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition only, first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0515T","name":"Insj wcs lv compl sys","description":"Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; complete system (includes electrode and generator [transmitter and battery])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":406.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10061","name":"I&d abscess comp/multiple","description":"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92504","name":"Ear microscopy examination","description":"Binocular microscopy (separate diagnostic procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50236","name":"Removal of kidney & ureter","description":"Nephrectomy with total ureterectomy and bladder cuff; through separate incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70490","name":"Ct soft tissue neck w/o dye","description":"Computed tomography, soft tissue neck; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42182","name":"Repair palate","description":"Repair, laceration of palate; over 2 cm or complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64891","name":"Nrv grf 1strnd hnd/foot >4cm","description":"Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0672","name":"Pressure pneum appl full arm","description":"Segmental gradient pressure pneumatic appliance, full arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4648","name":"Implantable tissue marker","description":"Tissue marker, implantable, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67400","name":"Explore/biopsy eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6675","name":"Harness figure of 8 sing con","description":"Upper extremity addition, harness, (e.g., figure of eight type), single cable design","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0109T","name":"Heat quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using heat-pain stimuli to assess small nerve fiber sensation and hyperalgesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2650","name":"Pelv & thor control gluteal","description":"Addition to lower extremity, pelvic and thoracic control, gluteal pad, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0249","name":"Provide inr test mater/equip","description":"Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81284","name":"Fxn gene detc abnor alleles","description":"Fxn (frataxin) (eg, friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28230","name":"Incision of foot tendon(s)","description":"Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45111","name":"Partial removal of rectum","description":"Proctectomy; partial resection of rectum, transabdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5052","name":"Clsd ostomy pouch w/o barr","description":"Ostomy pouch, closed; without barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2762","name":"Polarization, any lens","description":"Polarization, any lens material, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80150","name":"Assay of amikacin","description":"Amikacin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2625","name":"Adj skin pro/pos wc cus>=22","description":"Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1038","name":"Transport chair pt wt<=300lb","description":"Transport chair, adult size, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76506","name":"Echo exam of head","description":"Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnormalities), including a-mode encephalography as secondary component where indicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93226","name":"Xtrnl ecg rec<48 hr scan a/r","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1030","name":"W/c vent tray gimbaled","description":"Wheelchair accessory, ventilator tray, gimbaled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0829","name":"Pwc gp 2 xtra hd cap chair","description":"Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25825","name":"Arthrd wrist with autograft","description":"Arthrodesis, wrist; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56637","name":"Vlvctmy rad comp bi lymphad","description":"Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":947.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35820","name":"Explore chest vessels","description":"Exploration for postoperative hemorrhage, thrombosis or infection; chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1749.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43107","name":"Removal of esophagus","description":"Total or near total esophagectomy, without thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (transhiatal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2482.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47146","name":"Prep donor liver/venous","description":"Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; venous anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23410","name":"Repair rotator cuff acute","description":"Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85613","name":"Russell viper venom diluted","description":"Russell viper venom time (includes venom); diluted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76965","name":"Echo guidance radiotherapy","description":"Ultrasonic guidance for interstitial radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67115","name":"Release encircling material","description":"Release of encircling material (posterior segment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21196","name":"Reconst lwr jaw w/fixation","description":"Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1151.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0130","name":"Single energy x-ray study","description":"Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49568","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":224.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50840","name":"Replace ureter by bowel","description":"Replacement of all or part of ureter by intestine segment, including intestine anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":994.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35351","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; iliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1130.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31360","name":"Removal of larynx","description":"Laryngectomy; total, without radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1556.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25393","name":"Lengthen radius & ulna","description":"Osteoplasty, radius and ulna; lengthening with autograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27893","name":"Decompression of leg","description":"Decompression fasciotomy, leg; posterior compartment(s) only, with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74328","name":"X-ray bile duct endoscopy","description":"Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89190","name":"Nasal smear for eosinophils","description":"Nasal smear for eosinophils","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84166","name":"Protein e-phoresis/urine/csf","description":"Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, csf)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47556","name":"Biliary endoscopy thru skin","description":"Biliary endoscopy, percutaneous via t-tube or other tract; with dilation of biliary duct stricture(s) with stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":284.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11922","name":"Correct skin color ea 20.0cm","description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33404","name":"Prepare heart-aorta conduit","description":"Construction of apical-aortic conduit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00537","name":"Anes cardiac ep procedures","description":"Anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6450","name":"Lt compres band >=5in/yd","description":"Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6698","name":"Add up-ex prosthes lock mech","description":"Addition to upper extremity prosthesis, lock mechanism, excludes socket insert","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0006","name":"Heavy duty wheelchair","description":"Heavy duty wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26706","name":"Pin knuckle dislocation","description":"Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33255","name":"Ablate atria w/o bypass ext","description":"Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1410.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5988","name":"Vertical shock reducing pylo","description":"Addition to lower limb prosthesis, vertical shock reducing pylon feature","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11921","name":"Correct skn color 6.1-20.0cm","description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1227","name":"Wheelchair spec sz spec ht a","description":"Special height arms for wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00846","name":"Anes iper px rad hystrectomy","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; radical hysterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32504","name":"Resect apical lung tum/chest","description":"Resection of apical lung tumor (eg, pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; with chest wall reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1639.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33477","name":"Implant tcat pulm vlv perq","description":"Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49451","name":"Replace duod/jej tube perc","description":"Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24435","name":"Rpr non/mal hum with agrft","description":"Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":906.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2522","name":"Cntct lens hydrophil bifocl","description":"Contact lens, hydrophilic, bifocal, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82271","name":"Occult blood other sources","description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4624","name":"Tracheal suction tube","description":"Tracheal suction catheter, any type other than closed system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67715","name":"Canthotomy","description":"Canthotomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4306","name":"Drug delivery system <=50 ml","description":"Disposable drug delivery system, flow rate of less than 50 ml per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33241","name":"Remove pulse generator","description":"Removal of implantable defibrillator pulse generator only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99387","name":"Init pm e/m new pat 65+ yrs","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and old","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59025","name":"Fetal non-stress test","description":"Fetal non-stress test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36835","name":"Insertion thomas shunt","description":"Insertion of thomas shunt (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87480","name":"Candida dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); candida species, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4616","name":"Tubing (oxygen) per foot","description":"Tubing (oxygen), per foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5780","name":"Knee-shin pneum/hydra pneum","description":"Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":568.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84436","name":"Assay of total thyroxine","description":"Thyroxine; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4413","name":"2 pc drainable ost pouch","description":"Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29901","name":"Mcp joint arthroscopy surg","description":"Arthroscopy, metacarpophalangeal joint, surgical; with debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00454","name":"Anes px clav&scapula bx clav","description":"Anesthesia for procedures on clavicle and scapula; biopsy of clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7523","name":"Tracheostomy shower protect","description":"Tracheostomy shower protector, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86777","name":"Toxoplasma antibody","description":"Antibody; toxoplasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26770","name":"Treat finger dislocation","description":"Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1297","name":"Wheelchair special seat dept","description":"Special wheelchair seat depth, by upholstery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67973","name":"Reconstruction of eyelid","description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":558.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48154","name":"Pancreatectomy","description":"Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, whipple-type procedure); without pancreatojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85613","name":"Russell viper venom diluted","description":"Russell viper venom time (includes venom); diluted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23650","name":"Cltx sho dslc w/mnpj wo anes","description":"Closed treatment of shoulder dislocation, with manipulation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11440","name":"Exc face-mm b9+marg 0.5 cm/<","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27280","name":"Arthr si jt opn b1grf instrm","description":"Arthrodesis, sacroiliac joint, open, includes obtaining bone graft, including instrumentation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96367","name":"Tx/proph/dg addl seq iv inf","description":"Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0842","name":"Pwc gp2 std mult pow opt cap","description":"Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0637","name":"Combination sit to stand sys","description":"Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72295","name":"X-ray of lower spine disk","description":"Discography, lumbar, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5620","name":"Test socket below knee","description":"Addition to lower extremity, test socket, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67440","name":"Explore/drain eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); with drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22586","name":"Arthrd pre-sac ntrbdy l5-s1","description":"Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, l5-s1 interspace","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1848.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27822","name":"Treatment of ankle fracture","description":"Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27860","name":"Fixation of ankle joint","description":"Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55000","name":"Drainage of hydrocele","description":"Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2430","name":"Lens variable asphericity bi","description":"Variable asphericity lens, bifocal, full field, glass or plastic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63172","name":"Drainage of spinal cyst","description":"Laminectomy with drainage of intramedullary cyst/syrinx; to subarachnoid space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31290","name":"Nasal/sinus endoscopy surg","description":"Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid region","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36810","name":"Insertion of cannula","description":"Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external (scribner type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78813","name":"Pet image full body","description":"Positron emission tomography (pet) imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77789","name":"Apply surf ldr radionuclide","description":"Surface application of low dose rate radionuclide source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21485","name":"Cltx tmprmand dislc comp","description":"Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77762","name":"Apply intrcav radiat interm","description":"Intracavitary radiation source application; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":417.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0082","name":"Care man h v ext pt 30 m","description":"Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0241U","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2312","name":"Lens sphc trifo 7.25-12/2.25","description":"Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2570","name":"Hip clevis type 2 posit jnt","description":"Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP11","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74150","name":"Ct abdomen w/o contrast","description":"Computed tomography, abdomen; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2304","name":"Lens sphcy trifocal 4.0/2.25","description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 2.25-4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47381","name":"Open ablate liver tumor cryo","description":"Ablation, open, of 1 or more liver tumor(s); cryosurgical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2744","name":"Tint photochromatic lens/es","description":"Tint, photochromatic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65280","name":"Repair of eye wound","description":"Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":402.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92012","name":"Intrm oph exam est patient","description":"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51925","name":"Hysterectomy/bladder repair","description":"Closure of vesicouterine fistula; with hysterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71552","name":"Mri chest w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26502","name":"Hand tendon reconstruction","description":"Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":605.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11004","name":"Dbrdmt skin xtrnl gent&per","description":"Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":375.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57460","name":"Bx of cervix w/scope leep","description":"Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0859","name":"Mri compatible system","description":"Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":567.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1932","name":"Afo rig ant tib tcf/= custom","description":"Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":434.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83037","name":"Hb glycosylated a1c home dev","description":"Hemoglobin; glycosylated (a1c) by device cleared by fda for home use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0480","name":"Percussor elect/pneum home m","description":"Percussor, electric or pneumatic, home model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59025","name":"Fetal non-stress test","description":"Fetal non-stress test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31400","name":"Revision of larynx","description":"Arytenoidectomy or arytenoidopexy, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5618","name":"Test socket symes","description":"Addition to lower extremity, test socket, symes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99238","name":"Hosp ip/obs dschrg mgmt 30/<","description":"Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43330","name":"Esophagomyotomy abdominal","description":"Esophagomyotomy (heller type); abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27676","name":"Repair lower leg tendons","description":"Repair, dislocating peroneal tendons; with fibular osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29821","name":"Sho arthrs srg compl synvct","description":"Arthroscopy, shoulder, surgical; synovectomy, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55845","name":"Extensive prostate surgery","description":"Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65105","name":"Remove eye/attach implant","description":"Enucleation of eye; with implant, muscles attached to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99236","name":"Hosp ip/obs same date hi 85","description":"Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter f","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96105","name":"Assessment of aphasia","description":"Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by boston diagnostic aphasia examination) with interpretation and report, per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43283","name":"Lap esoph lengthening","description":"Laparoscopy, surgical, esophageal lengthening procedure (eg, collis gastroplasty or wedge gastroplasty) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94761","name":"N-invas ear/pls oximetry mlt","description":"Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45114","name":"Partial removal of rectum","description":"Proctectomy, partial, with anastomosis; abdominal and transsacral approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1526.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93041","name":"Rhythm ecg tracing","description":"Rhythm ecg, 1-3 leads; tracing only without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22868","name":"Insj stablj dev w/dcmprn","description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":219.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92620","name":"Auditory function 60 min","description":"Evaluation of central auditory function, with report; initial 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29876","name":"Arthrs knee surg synvct maj","description":"Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (eg, medial or lateral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22852","name":"Remove spine fixation device","description":"Removal of posterior segmental instrumentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01782","name":"Anes vn upr arm&elbw phlbrpy","description":"Anesthesia for procedures on veins of upper arm and elbow; phleborrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0884","name":"Pwc gp4 std mult pow opt s/b","description":"Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37193","name":"Rem endovas vena cava filter","description":"Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1282.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7027","name":"Combination oral/nasal mask","description":"Combination oral/nasal mask, used with continuous positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97761","name":"Prosthetic traing 1st enc","description":"Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82735","name":"Assay of fluoride","description":"Fluoride","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63290","name":"Bx/exc xdrl/idrl lsn any lvl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80190","name":"Assay of procainamide","description":"Procainamide;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95170","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole body extract of biting insect or other arthropod (specify number of doses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92532","name":"Positional nystagmus test","description":"Positional nystagmus test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95146","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 2 single stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4613","name":"Battery charger","description":"Battery charger; replacement for patient-owned ventilator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39010","name":"Exploration of chest","description":"Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; transthoracic approach, including either transthoracic or median sternotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6955","name":"Above elbow myoelectronic ct","description":"Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33920","name":"Repair pulmonary atresia","description":"Repair of pulmonary atresia with ventricular septal defect, by construction or replacement of conduit from right or left ventricle to pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1575.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32096","name":"Open wedge/bx lung infiltr","description":"Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97170","name":"Athletic trn eval mod cmplx","description":"Athletic training evaluation, moderate complexity, requiring these components: a medical history and physical activity profile with 1-2 comorbidities that affect physical activity; an examination of affected body area and other symptomatic or related systems addressing a total of 3 or more elements ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50630","name":"Removal of ureter stone","description":"Ureterolithotomy; lower one-third of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0810","name":"Halo cervical into jckt vest","description":"Halo procedure, cervical halo incorporated into jacket vest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1220.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66172","name":"Incision of eye","description":"Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0950","name":"Tray","description":"Wheelchair accessory, tray, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93225","name":"Xtrnl ecg rec<48 hrs rec","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20662","name":"Application halo pelvic","description":"Application of halo, including removal; pelvic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":431.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72146","name":"Mri chest spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0490","name":"Tlso rigid plastic pre one","description":"Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, res","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90870","name":"Electroconvulsive therapy","description":"Electroconvulsive therapy (includes necessary monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93321","name":"Doppler echo f-up/lmtd std","description":"Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); follow-up or limited study (list separately in addition to codes for echocardiographic imaging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35661","name":"Bpg femoral-femoral","description":"Bypass graft, with other than vein; femoral-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1990","name":"Afo doub solid stirrup calf","description":"Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar bk orthosis), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50070","name":"Nl comp cgen kdn abnormality","description":"Nephrolithotomy; complicated by congenital kidney abnormality","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":958.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90912","name":"Bfb training 1st 15 min","description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including emg and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0605","name":"Repl batt lithium 4.5 v","description":"Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92265","name":"Ndl oculoelectromyography 1+","description":"Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54450","name":"Preputial stretching","description":"Foreskin manipulation including lysis of preputial adhesions and stretching","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33963","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":407.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27893","name":"Decompression of leg","description":"Decompression fasciotomy, leg; posterior compartment(s) only, with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":514.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33244","name":"Remove elctrd transvenously","description":"Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88356","name":"Analysis nerve","description":"Morphometric analysis; nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5504","name":"Diabetic shoe with wedge","description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2100","name":"Lens spher single plano 4.00","description":"Sphere, single vision, plano to plus or minus 4.00, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61867","name":"Implant neuroelectrode","description":"Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2092.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26040","name":"Release palm contracture","description":"Fasciotomy, palmar (eg, dupuytrens contracture); percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":259.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66930","name":"Extraction of lens","description":"Removal of lens material; intracapsular, for dislocated lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":514.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77470","name":"Special radiation treatment","description":"Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral or endocavitary irradiation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93260","name":"Prgrmg dev eval impltbl sys","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99235","name":"Hosp ip/obs same date mod 70","description":"Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encount","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5093","name":"Ostomy accessory convex inse","description":"Ostomy accessory; convex insert","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33050","name":"Resect heart sac lesion","description":"Resection of pericardial cyst or tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83698","name":"Assay lipoprotein pla2","description":"Lipoprotein-associated phospholipase a2 (lp-pla2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58540","name":"Revision of uterus","description":"Hysteroplasty, repair of uterine anomaly (strassman type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":587.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76377","name":"3d render w/intrp postproces","description":"3d rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69960","name":"Release inner ear canal","description":"Decompression internal auditory canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50605","name":"Insert ureteral support","description":"Ureterotomy for insertion of indwelling stent, all types","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83615","name":"Lactate (ld) (ldh) enzyme","description":"Lactate dehydrogenase (ld), (ldh);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56805","name":"Clitoroplasty intersex state","description":"Clitoroplasty for intersex state","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96168","name":"Hlth bhv ivntj fam ea addl","description":"Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41110","name":"Excision of tongue lesion","description":"Excision of lesion of tongue without closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4363","name":"Ostomy clamp, replacement","description":"Ostomy clamp, any type, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43241","name":"Egd tube/cath insertion","description":"Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4257","name":"Replace lensshield cartridge","description":"Replacement lens shield cartridge for use with laser skin piercing device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2106","name":"Afo tib fx cast plaster mold","description":"Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67043","name":"Vit for membrane dissect","description":"Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and laser photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":726.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25259","name":"Manipulate wrist w/anesthes","description":"Manipulation, wrist, under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0864","name":"Pwc gp3 xhd mult pow opt s/b","description":"Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77520","name":"Proton trmt simple w/o comp","description":"Proton treatment delivery; simple, without compensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":577.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1222","name":"Wheelchair spec size w/ leg","description":"Wheelchair with fixed arm, elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53415","name":"Reconstruction of urethra","description":"Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":914.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47146","name":"Prep donor liver/venous","description":"Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; venous anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52341","name":"Cysto w/ureter stricture tx","description":"Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":229.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31625","name":"Bronchoscopy w/biopsy(s)","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88235","name":"Tissue culture placenta","description":"Tissue culture for non-neoplastic disorders; amniotic fluid or chorionic villus cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20824","name":"Replantation thumb complete","description":"Replantation, thumb (includes carpometacarpal joint to mp joint), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45397","name":"Lap remove rectum w/pouch","description":"Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, j-pouch), with diverting enterostomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33984","name":"Ecmo/ecls rmvl prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), open, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0862","name":"Pwc gp3 hd mult pow opt s/b","description":"Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93514","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4458","name":"Reusable enema bag","description":"Enema bag with tubing, reusable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01732","name":"Anes dx arthrs px elbow jt","description":"Anesthesia for diagnostic arthroscopic procedures of elbow joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25111","name":"Remove wrist tendon lesion","description":"Excision of ganglion, wrist (dorsal or volar); primary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52320","name":"Cystoscopy and treatment","description":"Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26471","name":"Fusion of finger tendons","description":"Tenodesis; of proximal interphalangeal joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":521.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31080","name":"Removal of frontal sinus","description":"Sinusotomy frontal; obliterative without osteoplastic flap, brow incision (includes ablation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":789.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92060","name":"Sensorimotor examination","description":"Sensorimotor examination with multiple measurements of ocular deviation (eg, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0851","name":"Pwc gp 3 hd cap chair","description":"Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0174","name":"Cerv sr 2pc thor ext pre ots","description":"Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96523","name":"Irrig drug delivery device","description":"Irrigation of implanted venous access device for drug delivery systems","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54430","name":"Revision of penis","description":"Corpora cavernosa-corpus spongiosum shunt (priapism operation), unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":517.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33788","name":"Revision of pulmonary artery","description":"Reimplantation of an anomalous pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1332.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35216","name":"Rpr blvsl dir ntrthrc wo byp","description":"Repair blood vessel, direct; intrathoracic, without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3908","name":"Who cock-up nonmolde pre ots","description":"Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10010","name":"Fna bx w/ct gdn ea addl","description":"Fine needle aspiration biopsy, including ct guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45321","name":"Proctosigmoidoscopy volvul","description":"Proctosigmoidoscopy, rigid; with decompression of volvulus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99253","name":"Ip/obs cnsltj new/est low 45","description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2370","name":"Pwr wc dr wh motor/gear comb","description":"Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15836","name":"Exc excessive skin arm","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":487.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96139","name":"Psycl/nrpsyc tst tech ea","description":"Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88319","name":"Enzyme histochemistry","description":"Special stain including interpretation and report; group iii, for enzyme constituents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28222","name":"Release of foot tendons","description":"Tenolysis, flexor, foot; multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0278","name":"Iliac art angio,cardiac cath","description":"Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, inj","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7026","name":"Replace chst cmprss sys hose","description":"High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99347","name":"Home/res vst est sf mdm 20","description":"Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 20 minutes must be met or exceede","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6410","name":"Sterile eye pad","description":"Eye pad, sterile, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29907","name":"Subtalar arthro w/fusion","description":"Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":740.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12001","name":"Rpr s/n/ax/gen/trnk 2.5cm/<","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19303","name":"Mast simple complete","description":"Mastectomy, simple, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21073","name":"Mnpj of tmj w/anesth","description":"Manipulation of temporomandibular joint(s) (tmj), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":306.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27005","name":"Tenotomy hip flexor open","description":"Tenotomy, hip flexor(s), open (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93541","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82487","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90953","name":"Esrd serv 1 visit p mo <2yrs","description":"End-stage renal disease (esrd) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01462","name":"Anes clsd px lower l/a/f","description":"Anesthesia for all closed procedures on lower leg, ankle, and foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84153","name":"Assay of psa total","description":"Prostate specific antigen (psa); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0200","name":"Cerv col supp adj bar & thor","description":"Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85345","name":"Coagulation time lee & white","description":"Coagulation time; lee and white","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59325","name":"Revision of cervix","description":"Cerclage of cervix, during pregnancy; abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":216.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65756","name":"Corneal trnspl endothelial","description":"Keratoplasty (corneal transplant); endothelial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":708.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91105","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73615","name":"Contrast x-ray of ankle","description":"Radiologic examination, ankle, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64493","name":"Inj paravert f jnt l/s 1 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), lumbar or sacral; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74220","name":"X-ray xm esophagus 1cntrst","description":"Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62000","name":"Treat skull fracture","description":"Elevation of depressed skull fracture; simple, extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86155","name":"Chemotaxis assay","description":"Chemotaxis assay, specify method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0622","name":"Sio flex pelvisacral custom","description":"Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45170","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9016","name":"Rbc leukocytes reduced","description":"Red blood cells, leukocytes reduced, each unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6218","name":"Non-sterile gauze > 48 sq in","description":"Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0141","name":"Rigid wheeled walker adj/fix","description":"Walker, rigid, wheeled, adjustable or fixed height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78258","name":"Esophageal motility","description":"Esophageal motility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0077","name":"Care manag h vst new pt 30 m","description":"Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56441","name":"Lysis of labial adhesions","description":"Lysis of labial adhesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2291","name":"Planar back for ped size wc","description":"Back, planar, for pediatric size wheelchair including fixed attaching hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67043","name":"Vit for membrane dissect","description":"Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and laser photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78491","name":"Myocrd img pet 1std rst/strs","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86329","name":"Immunodiffusion nes","description":"Immunodiffusion; not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92520","name":"Laryngeal function studies","description":"Laryngeal function studies (ie, aerodynamic testing and acoustic testing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0638","name":"Standing frame sys","description":"Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1805","name":"Adjust wrist ext & flex dev","description":"Dynamic adjustable wrist extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97024","name":"Diathermy eg microwave","description":"Application of a modality to 1 or more areas; diathermy (eg, microwave)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50750","name":"Fusion of ureter & kidney","description":"Ureterocalycostomy, anastomosis of ureter to renal calyx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP06","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2208","name":"Lens sphcy bifocal 4.25-7/2.","description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24365","name":"Reconstruct head of radius","description":"Arthroplasty, radial head;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":539.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52282","name":"Cystoscopy implant stent","description":"Cystourethroscopy, with insertion of permanent urethral stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":274.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44345","name":"Revision of colostomy","description":"Revision of colostomy; complicated (reconstruction in-depth) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71130","name":"X-ray strenoclavic jt 3/>vws","description":"Radiologic examination; sternoclavicular joint or joints, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21016","name":"Resect face/scalp tum 2 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; 2 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":844.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0072A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59200","name":"Insert cervical dilator","description":"Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11604","name":"Exc tr-ext mal+marg 3.1-4 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85292","name":"Clot factor fletcher fact","description":"Clotting; prekallikrein assay (fletcher factor assay)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21935","name":"Resect back tum < 5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":880.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7186","name":"Electron elbow child switch","description":"Electronic elbow, child, variety village or equal, switch controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5419.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57291","name":"Construction of vagina","description":"Construction of artificial vagina; without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86666","name":"Ehrlichia antibody","description":"Antibody; ehrlichia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84583","name":"Assay of urine urobilinogen","description":"Urobilinogen, urine; semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95875","name":"Limb exercise test","description":"Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68525","name":"Biopsy of tear sac","description":"Biopsy of lacrimal sac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83908","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01440","name":"Anes px art knee&pop nos","description":"Anesthesia for procedures on arteries of knee and popliteal area; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25500","name":"Cltx rdl shft fx w/o mnpj","description":"Closed treatment of radial shaft fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":230.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88172","name":"Cytp dx eval fna 1st ea site","description":"Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0220","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92613","name":"Endoscopy swallow (fees) i&r","description":"Flexible endoscopic evaluation of swallowing by cine or video recording; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31086","name":"Removal of frontal sinus","description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, brow incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99091","name":"Collj & interpj data ea 30 d","description":"Collection and interpretation of physiologic data (eg, ecg, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) r","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1834","name":"Ko w/0 joint rigid molded to","description":"Knee orthosis, without knee joint, rigid, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":409.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36800","name":"Insertion of cannula","description":"Insertion of cannula for hemodialysis, other purpose (separate procedure); vein to vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94762","name":"N-invas ear/pls oximtry cont","description":"Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4450","name":"Non-waterproof tape","description":"Tape, non-waterproof, per 18 square inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36832","name":"Av fistula revision open","description":"Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":662.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92552","name":"Pure tone audiometry air","description":"Pure tone audiometry (threshold); air only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90913","name":"Bfb training ea addl 15 min","description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including emg and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50431","name":"Njx px nfrosgrm &/urtrgrm","description":"Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":207.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51080","name":"Drainage of bladder abscess","description":"Drainage of perivesical or prevesical space abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26476","name":"Tendon lengthening","description":"Lengthening of tendon, extensor, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75940","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33229","name":"Remv&replc pm gen mult leads","description":"Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86906","name":"Bld typing serologic rh phnt","description":"Blood typing, serologic; rh phenotyping, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22318","name":"Treat odontoid fx w/o graft","description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1485.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27226","name":"Treat hip wall fracture","description":"Open treatment of posterior or anterior acetabular wall fracture, with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87521","name":"Hepatitis c probe&rvrs trnsc","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis c, amplified probe technique, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93651","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":727.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72220","name":"X-ray exam sacrum tailbone","description":"Radiologic examination, sacrum and coccyx, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95984","name":"Alys brn npgt prgrmg addl 15","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53240","name":"Surgery for urethra pouch","description":"Marsupialization of urethral diverticulum, male or female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":342.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26615","name":"Treat metacarpal fracture","description":"Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47801","name":"Placement bile duct support","description":"Placement of choledochal stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65875","name":"Incise inner eye adhesions","description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63017","name":"Remove spine lamina >2 lmbr","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1133.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6620","name":"Flexion/extension wrist unit","description":"Upper extremity addition, flexion/extension wrist unit, with or without friction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56634","name":"Vlvctmy rad comp uni lymphad","description":"Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":815.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48545","name":"Pancreatorrhaphy","description":"Pancreatorrhaphy for injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1128.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10004","name":"Fna bx w/o img gdn ea addl","description":"Fine needle aspiration biopsy, without imaging guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49180","name":"Biopsy abdominal mass","description":"Biopsy, abdominal or retroperitoneal mass, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93016","name":"Cv stress test supvj only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78812","name":"Pet image skull-thigh","description":"Positron emission tomography (pet) imaging; skull base to mid-thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1208.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0277","name":"Powered pres-redu air mattrs","description":"Powered pressure-reducing air mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34834","name":"Opn brach art expos","description":"Open brachial artery exposure for delivery of endovascular prosthesis, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95874","name":"Guide nerv destr needle emg","description":"Needle electromyography for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49605","name":"Repair umbilical lesion","description":"Repair of large omphalocele or gastroschisis; with or without prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90819","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22214","name":"Incis 1 vertebral seg lumbar","description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27216","name":"Treat pelvic ring fracture","description":"Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral (includes ipsilateral ilium, sacroiliac joint and/or sacrum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":709.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1232","name":"Folding ped wc tilt-in-space","description":"Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7026","name":"Replace chst cmprss sys hose","description":"High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31582","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1407.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82415","name":"Assay of chloramphenicol","description":"Chloramphenicol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74291","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95905","name":"Motor &/ sens nrve cndj test","description":"Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes f-wave study when performed, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37213","name":"Thromblytic art/ven therapy","description":"Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29425","name":"Appl short leg cast walking","description":"Application of short leg cast (below knee to toes); walking or ambulatory type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00220","name":"Anes icr px csf shunting px","description":"Anesthesia for intracranial procedures; cerebrospinal fluid shunting procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73115","name":"Contrast x-ray of wrist","description":"Radiologic examination, wrist, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2192","name":"Pelvic band & belt thigh fla","description":"Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00352","name":"Anes px maj vsl nck smpl lig","description":"Anesthesia for procedures on major vessels of neck; simple ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0639","name":"Lso s/c shell/panel prefab","description":"Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by ove","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0214T","name":"Njx paravert w/us cer/thor","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82157","name":"Assay of androstenedione","description":"Androstenedione","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01654","name":"Anes art sho&ax bypass grf","description":"Anesthesia for procedures on arteries of shoulder and axilla; bypass graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96130","name":"Psycl tst eval phys/qhp 1st","description":"Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14001","name":"Tis trnfr trunk 10.1-30sqcm","description":"Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94620","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2410","name":"Lens variab asphericity sing","description":"Variable asphericity lens, single vision, full field, glass or plastic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26843","name":"Fusion of hand joint","description":"Arthrodesis, carpometacarpal joint, digit, other than thumb, each;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":628.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43651","name":"Laparoscopy vagus nerve","description":"Laparoscopy, surgical; transection of vagus nerves, truncal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80400","name":"Acth stimulation panel","description":"Acth stimulation panel; for adrenal insufficiency this panel must include the following: cortisol (82533 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4369","name":"Skin barrier liquid per oz","description":"Ostomy skin barrier, liquid (spray, brush, etc.), per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01966","name":"Anes induced abortion px","description":"Anesthesia for induced abortion procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73590","name":"X-ray exam of lower leg","description":"Radiologic examination; tibia and fibula, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31610","name":"Tracheostomy fenest skin flp","description":"Tracheostomy, fenestration procedure with skin flaps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":719.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0600","name":"Suction pump portab hom modl","description":"Respiratory suction pump, home model, portable or stationary, electric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5795","name":"Exoskel hip ultra-light mate","description":"Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":533.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85384","name":"Fibrinogen activity","description":"Fibrinogen; activity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74250","name":"X-ray xm sm int 1cntrst std","description":"Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44322","name":"Colostomy with biopsies","description":"Colostomy or skin level cecostomy; with multiple biopsies (eg, for congenital megacolon) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26428","name":"Repair/graft finger tendon","description":"Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); with free graft (includes obtaining graft), each finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61566","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for selective amygdalohippocampectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2059.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27407","name":"Repair of knee ligament","description":"Repair, primary, torn ligament and/or capsule, knee; cruciate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99222","name":"1st hosp ip/obs moderate 55","description":"Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 55 minutes ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93320","name":"Doppler echo complete","description":"Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11951","name":"Subq njx fil matrl 1.1-5.0cc","description":"Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23505","name":"Cltx clavicular fx w/mnpj","description":"Closed treatment of clavicular fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":298.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29895","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47145","name":"Prep donor liver lobe split","description":"Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe spli","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1227","name":"Wheelchair spec sz spec ht a","description":"Special height arms for wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86753","name":"Protozoa antibody nos","description":"Antibody; protozoa, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29888","name":"Arthrs aid acl rpr/agmntj","description":"Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":826.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43652","name":"Laparoscopy vagus nerve","description":"Laparoscopy, surgical; transection of vagus nerves, selective or highly selective","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86705","name":"Hep b core antibody igm","description":"Hepatitis b core antibody (hbcab); igm antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60225","name":"Partial removal of thyroid","description":"Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89140","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25675","name":"Cltx dstl rad/uln dislc mnpj","description":"Closed treatment of distal radioulnar dislocation with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47563","name":"Laparo cholecystectomy/graph","description":"Laparoscopy, surgical; cholecystectomy with cholangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99366","name":"Team conf w/pat by hc prof","description":"Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50695","name":"Plmt ureteral stent prq","description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, with separate nephrostomy catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1126.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68840","name":"Explore/irrigate tear ducts","description":"Probing of lacrimal canaliculi, with or without irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47143","name":"Prep donor liver whole","description":"Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without triseg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15136","name":"Drm agrft f/s/n/h/f/g/m ea","description":"Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36200","name":"Place catheter in aorta","description":"Introduction of catheter, aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77407","name":"Radiation tx delivery lvl 2","description":"Radiation treatment delivery; level 2, single-isocenter (eg, 3d or imrt), photons, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82544","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0484","name":"Tlso rigid plastic cust fab","description":"Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by ov","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94012","name":"Spirmtry w/brnchdil inf-2 yr","description":"Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2116","name":"Afo tibial fracture rigid","description":"Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":396.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33858","name":"As-aort grf f/aortic dsj","description":"Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69667","name":"Repair middle ear structures","description":"Repair round window fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66850","name":"Removal of lens material","description":"Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88175","name":"Cytopath c/v auto fluid redo","description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51705","name":"Change of bladder tube","description":"Change of cystostomy tube; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7508","name":"Housing & integrated adhesiv","description":"Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90885","name":"Psy evaluation of records","description":"Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64898","name":"Nrv grf mltst arm/leg >4 cm","description":"Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1165.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77790","name":"Radiation handling","description":"Supervision, handling, loading of radiation source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4356","name":"Ext ureth clmp or compr dvc","description":"External urethral clamp or compression device (not to be used for catheter clamp), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00904","name":"Anes radical perineal px","description":"Anesthesia for; radical perineal procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56740","name":"Exc bartholins gland/cyst","description":"Excision of bartholins gland or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66840","name":"Removal of lens material","description":"Removal of lens material; aspiration technique, 1 or more stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95866","name":"Needle emg hemidiaphragm","description":"Needle electromyography; hemidiaphragm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1030","name":"Lumbar bolster pad","description":"Addition to ctlso or scoliosis orthosis, lumbar bolster pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3600","name":"Trans shoe calip plate exist","description":"Transfer of an orthosis from one shoe to another, caliper plate, existing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01850","name":"Anes vein f/arm wrst&hnd nos","description":"Anesthesia for procedures on veins of forearm, wrist, and hand; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49557","name":"Rerepair fem hernia blocked","description":"Repair recurrent femoral hernia; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":602.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26471","name":"Fusion of finger tendons","description":"Tenodesis; of proximal interphalangeal joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95145","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92132","name":"Cptrzd oph dx img ant sgm","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), anterior segment, with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99439","name":"Chrnc care mgmt staf ea addl","description":"Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or funct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72052","name":"X-ray exam neck spine 6/>vws","description":"Radiologic examination, spine, cervical; 6 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27687","name":"Revision of calf tendon","description":"Gastrocnemius recession (eg, strayer procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89300","name":"Semen analysis w/huhner","description":"Semen analysis; presence and/or motility of sperm including huhner test (post coital)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4266","name":"Diaphragm","description":"Diaphragm for contraceptive use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2210","name":"Dorsiflexion assist each joi","description":"Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S0190","name":"Mifepristone, oral, 200 mg","description":"Mifepristone, oral, 200 mg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4316","name":"Cath w/drainage 3-way","description":"Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31610","name":"Tracheostomy fenest skin flp","description":"Tracheostomy, fenestration procedure with skin flaps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95027","name":"Iq tsts seql&incrl airborne","description":"Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11640","name":"Exc f/e/e/n/l mal+mrg 0.5cm<","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0083","name":"Care man h v ext pt 45 m","description":"Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00811","name":"Anes lwr intst ndsc nos","description":"Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50300","name":"Remove cadaver donor kidney","description":"Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1093.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37208","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43213","name":"Esophagoscopy retro balloon","description":"Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"Q4098","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78600","name":"Brain image < 4 views","description":"Brain imaging, less than 4 static views;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58290","name":"Vag hyst complex","description":"Vaginal hysterectomy, for uterus greater than 250 g;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":740.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0816","name":"Pwc gp 1 std cap chair","description":"Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3202","name":"Oxford w/ supinat/pronator c","description":"Orthopedic shoe, oxford with supinator or pronator, child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99226","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4327","name":"Fem urinary collect dev cup","description":"Female external urinary collection device; meatal cup, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13132","name":"Cmplx rpr f/c/c/m/n/ax/g/h/f","description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70390","name":"X-ray exam of salivary duct","description":"Sialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0720","name":"Tens two lead","description":"Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65175","name":"Removal of ocular implant","description":"Removal of ocular implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":433.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27664","name":"Repair of leg tendon each","description":"Repair, extensor tendon, leg; primary, without graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00542","name":"Anes thrcm px decortication","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); decortication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33732","name":"Repair heart-vein defect","description":"Repair of cor triatriatum or supravalvular mitral ring by resection of left atrial membrane","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1430.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33518","name":"Cabg artery-vein two","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87340","name":"Hepatitis b surface ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hepatitis b surface antigen (hbsag)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79200","name":"Nuclear rx intracav admin","description":"Radiopharmaceutical therapy, by intracavitary administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25065","name":"Biopsy forearm soft tissues","description":"Biopsy, soft tissue of forearm and/or wrist; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70260","name":"X-ray exam of skull","description":"Radiologic examination, skull; complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25300","name":"Fusion of tendons at wrist","description":"Tenodesis at wrist; flexors of fingers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":571.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65780","name":"Ocular reconst transplant","description":"Ocular surface reconstruction; amniotic membrane transplantation, multiple layers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24330","name":"Flexor-plasty elbow","description":"Flexor-plasty, elbow (eg, steindler type advancement);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95830","name":"Insert electrodes for eeg","description":"Insertion by physician or other qualified health care professional of sphenoidal electrodes for electroencephalographic (eeg) recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37145","name":"Revision of circulation","description":"Venous anastomosis, open; renoportal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01780","name":"Anes px vn upr arm&elbw nos","description":"Anesthesia for procedures on veins of upper arm and elbow; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86828","name":"Hla class i&ii antibody qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to hla class i and class ii hla antigens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70496","name":"Ct angiography head","description":"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87652","name":"Strep a dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); streptococcus, group a, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12047","name":"Intmd rpr n-hf/genit >30.0cm","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0407","name":"Inpt/tele follow up 25","description":"Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58541","name":"Lsh uterus 250 g or less","description":"Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23044","name":"Arthrt ac sc jt exp/rmvl fb","description":"Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27179","name":"Revise head/neck of femur","description":"Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (heyman type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96159","name":"Hlth bhv ivntj indiv ea addl","description":"Health behavior intervention, individual, face-to-face; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87536","name":"Hiv-1 quant&revrse trnscrpj","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-1, quantification, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6217","name":"Non-sterile gauze>16<=48 sq","description":"Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0482","name":"Microprcsr cu combo vad, rep","description":"Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2217.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28005","name":"Treat foot bone lesion","description":"Incision, bone cortex (eg, osteomyelitis or bone abscess), foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9483","name":"Remote e/m new pt 30mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real tim","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33464","name":"Valvuloplasty tricuspid","description":"Valvuloplasty, tricuspid valve; with ring insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83918","name":"Organic acids total quant","description":"Organic acids; total, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93229","name":"Remote 30 day ecg tech supp","description":"External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ecg data storage (retrievable with query) with ecg triggered and patient selected events transmitted to a remote attended surveillance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":697.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84157","name":"Assay of protein other","description":"Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4558","name":"Conductive gel or paste","description":"Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28171","name":"Resect tarsal tumor","description":"Radical resection of tumor; tarsal (except talus or calcaneus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":941.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85337","name":"Thrombomodulin","description":"Thrombomodulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29025","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85014","name":"Hematocrit","description":"Blood count; hematocrit (hct)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75898","name":"Follow-up angiography","description":"Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4212","name":"Non coring needle or stylet","description":"Non-coring needle or stylet with or without catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64910","name":"Nerve repair w/allograft","description":"Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87557","name":"M.tuberculo dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria tuberculosis, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01969","name":"Anes c hyst flwg neuraxial","description":"Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92588","name":"Evoked auditory tst complete","description":"Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94681","name":"O2 uptk co2 outp % o2 xtrc","description":"Oxygen uptake, expired gas analysis; including co2 output, percentage oxygen extracted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0008","name":"Admin influenza virus vac","description":"Administration of influenza virus vaccine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92601","name":"Cochlear implt f/up exam <7","description":"Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23335","name":"Shoulder prosthesis removal","description":"Removal of prosthesis, includes debridement and synovectomy when performed; humeral and glenoid components (eg, total shoulder)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1073.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77078","name":"Ct bone density axial","description":"Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95955","name":"Eeg during surgery","description":"Electroencephalogram (eeg) during nonintracranial surgery (eg, carotid surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62230","name":"Replace/revise brain shunt","description":"Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1876","name":"Stent, non-coa/non-cov w/del","description":"Stent, non-coated/non-covered, with delivery system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1732.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56625","name":"Vulvectomy simple complete","description":"Vulvectomy simple; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0101","name":"Ca screen;pelvic/breast exam","description":"Cervical or vaginal cancer screening; pelvic and clinical breast examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69666","name":"Repair middle ear structures","description":"Repair oval window fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":651.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92979","name":"Endoluminl ivus oct c ea","description":"Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (list separately in addition to co","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87084","name":"Culture of specimen by kit","description":"Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20931","name":"Sp bone algrft struct add-on","description":"Allograft, structural, for spine surgery only (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0445","name":"High inten beh couns std 30m","description":"High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4706","name":"Bicarbonate conc sol per gal","description":"Bicarbonate concentrate, solution, for hemodialysis, per gallon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77321","name":"Special teletx port plan","description":"Special teletherapy port plan, particles, hemibody, total body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00548","name":"Anes thrcm px trach&bronchi","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); intrathoracic procedures on the trachea and bronchi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88366","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99474","name":"Self-meas bp 2 readg bid 30d","description":"Self-measured blood pressure using a device validated for clinical accuracy; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61581","name":"Craniofacial approach skull","description":"Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy and/or maxillectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2177.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0010","name":"Stnd wt frame power whlchr","description":"Standard - weight frame motorized/power wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86352","name":"Cell function assay w/stim","description":"Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, atp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68362","name":"Revise eyelid lining","description":"Conjunctival flap; total (such as gunderson thin flap or purse string flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55920","name":"Place needles pelvic for rt","description":"Placement of needles or catheters into pelvic organs and/or genitalia (except prostate) for subsequent interstitial radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13152","name":"Cmplx rpr e/n/e/l 2.6-7.5 cm","description":"Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":310.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87480","name":"Candida dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); candida species, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0300","name":"Enclosed ped crib hosp grade","description":"Pediatric crib, hospital grade, fully enclosed, with or without top enclosure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5686","name":"Bk back check","description":"Addition to lower extremity, below knee, back check (extension control)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01680","name":"Anes sho cast appl rmvl/rpr","description":"Anesthesia for shoulder cast application, removal or repair, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26117","name":"Rad resect hand tumor < 3 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23665","name":"Cltx sho dslc fx gr hmrl tbr","description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21337","name":"Closed tx septal&nose fx","description":"Closed treatment of nasal septal fracture, with or without stabilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63086","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36430","name":"Transfusion bld/bld compnt","description":"Transfusion, blood or blood components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27000","name":"Tenotomy adductor hip perq","description":"Tenotomy, adductor of hip, percutaneous (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99472","name":"Ped critical care subsq","description":"Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29358","name":"Appl long leg cast brace","description":"Application of long leg cast brace","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93798","name":"Phys/qhp op car rhab w/ecg","description":"Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ecg monitoring (per session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6000","name":"Part hand thumb rem","description":"Partial hand, thumb remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":674.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72255","name":"Myelography thoracic spine","description":"Myelography, thoracic, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33235","name":"Removal pacemaker electrode","description":"Removal of transvenous pacemaker electrode(s); dual lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":549.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84479","name":"Assay of thyroid (t3 or t4)","description":"Thyroid hormone (t3 or t4) uptake or thyroid hormone binding ratio (thbr)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26607","name":"Treat metacarpal fracture","description":"Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":406.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82379","name":"Assay of carnitine","description":"Carnitine (total and free), quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72158","name":"Mri lumbar spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72070","name":"X-ray exam thorac spine 2vws","description":"Radiologic examination, spine; thoracic, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0640","name":"Lso s/c shell/panel custom","description":"Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by ove","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63271","name":"Excise intrspinl lesion thrc","description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5654","name":"Socket insert symes","description":"Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23100","name":"Arthrotomy glenhumrl jt w/bx","description":"Arthrotomy, glenohumeral joint, including biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":423.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99379","name":"Nursing fac care supervision","description":"Supervision of a nursing facility patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, comm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75650","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31390","name":"Removal of larynx & pharynx","description":"Pharyngolaryngectomy, with radical neck dissection; without reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2126.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0180","name":"Cer post col occ/man sup adj","description":"Cervical, multiple post collar, occipital/mandibular supports, adjustable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64421","name":"Njx aa&/strd ntrcost nrv ea","description":"Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4714","name":"Treated water per gallon","description":"Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2188","name":"Quadrilateral brim","description":"Addition to lower extremity fracture orthosis, quadrilateral brim","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11001","name":"Dbrdmt ecz/infct skn ea addl","description":"Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0397","name":"Alcohol/subs interv >30 min","description":"Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32656","name":"Thoracoscopy w/pleurectomy","description":"Thoracoscopy, surgical; with parietal pleurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76376","name":"3d render w/intrp postproces","description":"3d rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42550","name":"Injection for salivary x-ray","description":"Injection procedure for sialography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21085","name":"Impres&prep oral surg splint","description":"Impression and custom preparation; oral surgical splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":559.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4216","name":"Sterile water/saline, 10 ml","description":"Sterile water, saline and/or dextrose, diluent/flush, 10 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26665","name":"Treat thumb fracture","description":"Open treatment of carpometacarpal fracture dislocation, thumb (bennett fracture), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61797","name":"Srs cran les simple addl","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, simple (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92990","name":"Revision of pulmonary valve","description":"Percutaneous balloon valvuloplasty; pulmonary valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33231","name":"Insrt pulse gen w/mult leads","description":"Insertion of implantable defibrillator pulse generator only; with existing multiple leads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49905","name":"Omental flap intra-abdom","description":"Omental flap, intra-abdominal (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82272","name":"Occult bld feces 1-3 tests","description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43641","name":"Vagotomy & pylorus repair","description":"Vagotomy including pyloroplasty, with or without gastrostomy; parietal cell (highly selective)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78645","name":"Csf shunt evaluation","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67808","name":"Remove eyelid lesion(s)","description":"Excision of chalazion; under general anesthesia and/or requiring hospitalization, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78071","name":"Parathyrd planar w/wo subtrj","description":"Parathyroid planar imaging (including subtraction, when performed); with tomographic (spect)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90954","name":"Esrd serv 4 vsts p mo 2-11","description":"End-stage renal disease (esrd) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":573.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99462","name":"Sbsq nb em per day hosp","description":"Subsequent hospital care, per day, for evaluation and management of normal newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1280","name":"Whchr h-duty det arm leg res","description":"Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33403","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1258.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26261","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":497.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63020","name":"Lamot dcmprn nrv rt 1 cerv","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1027.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95965","name":"Meg spontaneous","description":"Magnetoencephalography (meg), recording and analysis; for spontaneous brain magnetic activity (eg, epileptic cerebral cortex localization)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86692","name":"Hepatitis delta agent antbdy","description":"Antibody; hepatitis, delta agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45384","name":"Colonoscopy w/lesion removal","description":"Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":367.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99190","name":"Special pump services","description":"Assembly and operation of pump with oxygenator or heat exchanger (with or without ecg and/or pressure monitoring); each hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43326","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":988.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31780","name":"Reconstruct windpipe","description":"Excision tracheal stenosis and anastomosis; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":898.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97811","name":"Acup 1/> w/o estim ea add 15","description":"Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with insertion of needle(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4153","name":"Ef hydrolyzed/amino acids","description":"Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97813","name":"Acup 1/> w/estim 1st 15 min","description":"Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0243","name":"Toilet rail","description":"Toilet rail, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46270","name":"Remove anal fist subq","description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":416.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95807","name":"Sleep study attended","description":"Sleep study, simultaneous recording of ventilation, respiratory effort, ecg or heart rate, and oxygen saturation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50945","name":"Laparoscopy ureterolithotomy","description":"Laparoscopy, surgical; ureterolithotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":785.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28054","name":"Biopsy of toe joint lining","description":"Arthrotomy with biopsy; interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1223","name":"Wheelchair spec size w foot","description":"Wheelchair with detachable arms, footrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27333","name":"Removal of knee cartilage","description":"Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial and lateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72081","name":"X-ray exam entire spi 1 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23395","name":"Muscle transfer shoulder/arm","description":"Muscle transfer, any type, shoulder or upper arm; single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1084.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0575","name":"Nebulizer ultrasonic","description":"Nebulizer, ultrasonic, large volume","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52290","name":"Cystoscopy and treatment","description":"Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24685","name":"Optx ulnar fx prox end w/fix","description":"Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27335","name":"Remove knee joint lining","description":"Arthrotomy, with synovectomy, knee; anterior and posterior including popliteal area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":645.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66986","name":"Exchange lens prosthesis","description":"Exchange of intraocular lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33736","name":"Revision of heart chamber","description":"Atrial septectomy or septostomy; open heart with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27742","name":"Repair of leg epiphyses","description":"Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula; and distal femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28238","name":"Revision of foot tendon","description":"Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, kidner type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":538.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42900","name":"Repair throat wound","description":"Suture pharynx for wound or injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":259.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2503","name":"Cntct lens pmma color vision","description":"Contact lens, pmma, color vision deficiency, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28306","name":"Incision of metatarsal","description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":495.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78460","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92987","name":"Revision of mitral valve","description":"Percutaneous balloon valvuloplasty; mitral valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27519","name":"Treat thigh fx growth plate","description":"Open treatment of distal femoral epiphyseal separation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3710","name":"Eo elas w/metal jnts pre ots","description":"Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8040","name":"Nasal prosthesis","description":"Nasal prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","KM","95","93","NU","","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77013","name":"Ct guide for tissue ablation","description":"Computed tomography guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82747","name":"Assay of folic acid rbc","description":"Folic acid; rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97803","name":"Med nutrition indiv subseq","description":"Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0508","name":"Crit care telehea consult 60","description":"Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86225","name":"Dna antibody native","description":"Deoxyribonucleic acid (dna) antibody; native or double stranded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87534","name":"Hiv-1 dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-1, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77402","name":"Radiation tx delivery lvl 1","description":"Radiation treatment delivery; level 1 (eg, single-electron field, multiple-electron fields, or 2d photons), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2000","name":"Gastric suction pump hme mdl","description":"Gastric suction pump, home model, portable or stationary, electric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43210","name":"Egd esophagogastrc fndoplsty","description":"Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35371","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; common femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":718.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27070","name":"Part remove hip bone super","description":"Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":739.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3630","name":"Trans shoe solid stirrup new","description":"Transfer of an orthosis from one shoe to another, solid stirrup, new","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35570","name":"Art byp tibial-tib/peroneal","description":"Bypass graft, with vein; tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3310","name":"Shoe lift elev heel/sole neo","description":"Lift, elevation, heel and sole, neoprene, per inch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68815","name":"Probe nasolacrimal duct","description":"Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78483","name":"Heart first pass multiple","description":"Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4354","name":"Cath insertion tray w/bag","description":"Insertion tray with drainage bag but without catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99469","name":"Neonate crit care subsq","description":"Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2225","name":"Caster wheel excludes tire","description":"Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93566","name":"Njx car cth slctv rv/ra ang","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01991","name":"Anes dx/ther nrv blk&inj oth","description":"Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); other than the prone position","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64766","name":"Incise hip/thigh nerve","description":"Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":550.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75827","name":"Vein x-ray chest","description":"Venography, caval, superior, with serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0209T","name":"Audiometry air & bone","description":"Pure tone audiometry (threshold), automated; air and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27540","name":"Treat knee fracture","description":"Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":683.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24079","name":"Rad rescj tum tiss a/e 5 cm+","description":"Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28495","name":"Treat big toe fracture","description":"Closed treatment of fracture great toe, phalanx or phalanges; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38765","name":"Remove groin lymph nodes","description":"Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86922","name":"Compatibility test antiglob","description":"Compatibility test each unit; antiglobulin technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65779","name":"Cover eye w/membrane suture","description":"Placement of amniotic membrane on the ocular surface; single layer, sutured","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44055","name":"Correct malrotation of bowel","description":"Correction of malrotation by lysis of duodenal bands and/or reduction of midgut volvulus (eg, ladd procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78647","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":281.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5060","name":"Symes met fr leath socket ar","description":"Ankle, symes, metal frame, molded leather socket, articulated ankle/foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1827.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0274T","name":"Prq lamot/lam dcmpr crv/thrc","description":"Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, ct), single or multiple levels, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52343","name":"Cysto w/renal stricture tx","description":"Cystourethroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22532","name":"Arthrd lat xtrcvtry tq thrc","description":"Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1603.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33724","name":"Repair venous anomaly","description":"Repair of isolated partial anomalous pulmonary venous return (eg, scimitar syndrome)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1337.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44130","name":"Bowel to bowel fusion","description":"Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1091.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49652","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":620.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73000","name":"X-ray exam of collar bone","description":"Radiologic examination; clavicle, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20802","name":"Replantation arm complete","description":"Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00470","name":"Anes partial rib rescj nos","description":"Anesthesia for partial rib resection; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27228","name":"Treat hip fracture(s)","description":"Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes t-fracture and both column fracture with complete articular detachment, or single column or transverse fracture with associated acetabular wall fracture, with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1594.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96165","name":"Hlth bhv ivntj grp ea addl","description":"Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5694","name":"Ak pelvic control belt pad/l","description":"Addition to lower extremity, above knee, pelvic control belt, padded and lined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50700","name":"Revision of ureter","description":"Ureteroplasty, plastic operation on ureter (eg, stricture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60254","name":"Extensive thyroid surgery","description":"Thyroidectomy, total or subtotal for malignancy; with radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63744","name":"Revision of spinal shunt","description":"Replacement, irrigation or revision of lumbosubarachnoid shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77084","name":"Mri bone marrow blood supply","description":"Magnetic resonance (eg, proton) imaging, bone marrow blood supply","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45338","name":"Sigmoidoscopy w/tumr remove","description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":218.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58300","name":"Insert intrauterine device","description":"Insertion of intrauterine device (iud)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88305","name":"Tissue exam by pathologist","description":"Level iv - surgical pathology, gross and microscopic examination abortion - spontaneous/missed artery, biopsy bone marrow, biopsy bone exostosis brain/meninges, other than for tumor resection breast, biopsy, not requiring microscopic evaluation of surgical margins breast, reduction mammoplasty bronc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4256","name":"Calibrator solution/chips","description":"Normal, low and high calibrator solution / chips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97012","name":"Mechanical traction therapy","description":"Application of a modality to 1 or more areas; traction, mechanical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15170","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":310.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27447","name":"Total knee arthroplasty","description":"Arthroplasty, knee, condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50555","name":"Kidney endoscopy & biopsy","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4428","name":"Urine ost pouch w faucet/tap","description":"Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33944","name":"Prepare donor heart","description":"Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24116","name":"Exc/crtg b1 cst/tum hum algr","description":"Excision or curettage of bone cyst or benign tumor, humerus; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":728.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90951","name":"Esrd serv 4 visits p mo <2yr","description":"End-stage renal disease (esrd) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care pro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67710","name":"Severing tarsorrhaphy","description":"Severing of tarsorrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4360","name":"Disposable ext urethral dev","description":"Disposable external urethral clamp or compression device, with pad and/or pouch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64708","name":"Revise arm/leg nerve","description":"Neuroplasty, major peripheral nerve, arm or leg, open; other than specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":421.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28295","name":"Cor hlx vlgs prx mtar osteot","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal metatarsal osteotomy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":805.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23490","name":"Reinforce clavicle","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7504","name":"Tracheostoma hmes filter","description":"Filter for use in a tracheostoma heat and moisture exchange system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84181","name":"Western blot test","description":"Protein; western blot, with interpretation and report, blood or other body fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24342","name":"Repair of ruptured tendon","description":"Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1850","name":"Ko swedish type pre ots","description":"Knee orthosis, swedish type, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2510","name":"Th/wght bear quad-lat brim m","description":"Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":394.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31233","name":"Nsl/sins ndsc dx max sinusc","description":"Nasal/sinus endoscopy, diagnostic; with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99116","name":"Anes comp tot bdy hypthrm","description":"Anesthesia complicated by utilization of total body hypothermia (list separately in addition to code for primary anesthesia procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63250","name":"Revise spinal cord vsls crvl","description":"Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61850","name":"Implant neuroelectrodes","description":"Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":894.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0295","name":"Hosp bed semi-elect w/o matt","description":"Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S9152","name":"Speech therapy, re-eval","description":"Speech therapy, re-evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3913","name":"Hfo w/o joints cf","description":"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86644","name":"Cmv antibody","description":"Antibody; cytomegalovirus (cmv)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75962","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23585","name":"Optx scapular fx w/int fixj","description":"Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":826.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47540","name":"Perq plmt bile duct stent","description":"Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; new access,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3710.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43772","name":"Lap rmvl gastr adj device","description":"Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":797.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20956","name":"Iliac bone graft microvasc","description":"Bone graft with microvascular anastomosis; iliac crest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2246.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33959","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47537","name":"Removal biliary drg cath","description":"Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3465","name":"Shoe heel thomas with wedge","description":"Heel, thomas with wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84703","name":"Chorionic gonadotropin assay","description":"Gonadotropin, chorionic (hcg); qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82784","name":"Assay iga/igd/igg/igm each","description":"Gammaglobulin (immunoglobulin); iga, igd, igg, igm, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87850","name":"N. gonorrhoeae assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; neisseria gonorrhoeae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29584","name":"Appl mltlay cmprn sys up arm","description":"Application of multi-layer compression system; upper arm, forearm, hand, and fingers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51725","name":"Simple cystometrogram","description":"Simple cystometrogram (cmg) (eg, spinal manometer)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44970","name":"Laparoscopy appendectomy","description":"Laparoscopy, surgical, appendectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6447","name":"Conform band s w >=5in/yd","description":"Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0859","name":"Mri compatible system","description":"Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27457","name":"Realignment of knee","description":"Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); after epiphyseal closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":814.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1050","name":"Whelchr fxd full length arms","description":"Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53430","name":"Reconstruction of urethra","description":"Urethroplasty, reconstruction of female urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5670","name":"Bk molded supracondylar susp","description":"Addition to lower extremity, below knee, molded supracondylar suspension (pts or similar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83150","name":"Assay of homovanillic acid","description":"Homovanillic acid (hva)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0312","name":"Immunize couns < 21yr 5-15 m","description":"Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67041","name":"Vit for macular pucker","description":"Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":689.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95822","name":"Eeg coma or sleep only","description":"Electroencephalogram (eeg); recording in coma or sleep only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64416","name":"Njx aa&/strd brch pl nfs img","description":"Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99422","name":"Ol dig e/m svc 11-20 min","description":"Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5460","name":"Postop app non-wgt bear dsg","description":"Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":271.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33365","name":"Replace aortic valve open","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46753","name":"Reconstruction of anus","description":"Graft (thiersch operation) for rectal incontinence and/or prolapse","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86300","name":"Immunoassay tumor ca 15-3","description":"Immunoassay for tumor antigen, quantitative; ca 15-3 (27.29)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58943","name":"Removal of ovary(s)","description":"Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy(s), with or without omentectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6100","name":"Elb mold sock flex hinge pad","description":"Below elbow, molded socket, flexible elbow hinge, triceps pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1273.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52224","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of minor (less than 0.5 cm) lesion(s) with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":616.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68340","name":"Separate eyelid adhesions","description":"Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11954","name":"Subq njx fil matrl>10.0 cc","description":"Subcutaneous injection of filling material (eg, collagen); over 10.0 cc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36500","name":"Insertion of catheter vein","description":"Venous catheterization for selective organ blood sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4368","name":"Ostomy filter","description":"Ostomy filter, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31601","name":"Planned tracheostomy<2 yrs","description":"Tracheostomy, planned (separate procedure); younger than 2 years","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45563","name":"Exploration/repair of rectum","description":"Exploration, repair, and presacral drainage for rectal injury; with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0940","name":"Trapeze bar free standing","description":"Trapeze bar, free standing, complete with grab bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62270","name":"Dx lmbr spi pnxr","description":"Spinal puncture, lumbar, diagnostic;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26037","name":"Decompress fingers/hand","description":"Decompressive fasciotomy, hand (excludes 26035)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":474.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83690","name":"Assay of lipase","description":"Lipase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23466","name":"Repair shoulder capsule","description":"Capsulorrhaphy, glenohumeral joint, any type multidirectional instability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0278","name":"Iliac art angio,cardiac cath","description":"Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, inj","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2215","name":"Lens lenticular bifocal","description":"Lenticular (myodisc), per lens, bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44366","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59140","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; cervical, with evacuation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59412","name":"Antepartum manipulation","description":"External cephalic version, with or without tocolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54050","name":"Destruction penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21435","name":"Optx crnfc sep comp int&/xtr","description":"Open treatment of craniofacial separation (lefort iii type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82926","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66770","name":"Removal of inner eye lesion","description":"Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2361","name":"22nf sealed leadacid battery","description":"Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40652","name":"Rpr lip fth<half ver height","description":"Repair lip, full thickness; up to half vertical height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0606","name":"Drainage board postural","description":"Postural drainage board","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61690","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; dural, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2000.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37140","name":"Revision of circulation","description":"Venous anastomosis, open; portocaval","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51597","name":"Removal of pelvic structures","description":"Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16020","name":"Dress/debrid p-thick burn s","description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3982","name":"Upper ext fx orthosis rad/ul","description":"Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":227.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50684","name":"Injection for ureter x-ray","description":"Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33120","name":"Exc icar tum resc w/card byp","description":"Excision of intracardiac tumor, resection with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1821.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38530","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, internal mammary node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40844","name":"Reconstruction of mouth","description":"Vestibuloplasty; entire arch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33367","name":"Replace aortic valve w/byp","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":550.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87197","name":"Serum bactericidal titer","description":"Serum bactericidal titer (schlichter test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99211","name":"Off/op est may x req phy/qhp","description":"Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4050","name":"Replace molded calf lacer","description":"Replace molded calf lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":256.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1843","name":"Ko single upright pre cst","description":"Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a sp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15738","name":"Muscle-skin graft leg","description":"Muscle, myocutaneous, or fasciocutaneous flap; lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":838.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11622","name":"Exc s/n/h/f/g mal+mrg 1.1-2","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92973","name":"Prq trluml c mchn asp thrmbc","description":"Percutaneous transluminal coronary mechanical aspiration thrombectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0111","name":"Wet mounts/ w preparations","description":"Wet mounts, including preparations of vaginal, cervical or skin specimens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28126","name":"Partial removal of toe","description":"Resection, partial or complete, phalangeal base, each toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87801","name":"Detect agnt mult dna ampli","description":"Infectious agent detection by nucleic acid (dna or rna), multiple organisms; amplified probe(s) technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78075","name":"Adrenal cortex & medulla img","description":"Adrenal imaging, cortex and/or medulla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22869","name":"Insj stablj dev w/o dcmprn","description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46760","name":"Repair of anal sphincter","description":"Sphincteroplasty, anal, for incontinence, adult; muscle transplant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":851.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49425","name":"Insert abdomen-venous drain","description":"Insertion of peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":575.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86000","name":"Agglutinins febrile antigen","description":"Agglutinins, febrile (eg, brucella, francisella, murine typhus, q fever, rocky mountain spotted fever, scrub typhus), each antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55875","name":"Transperi needle place pros","description":"Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":618.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25680","name":"Cltx trns-scphprlnr fx mnpj","description":"Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73722","name":"Mri joint of lwr extr w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95713","name":"Veeg 2-12 hr cont mntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, 2-12 hours; with continuous, real-time monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19340","name":"Insj breast implt sm d mast","description":"Insertion of breast implant on same day of mastectomy (ie, immediate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65205","name":"Remove foreign body from eye","description":"Removal of foreign body, external eye; conjunctival superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34713","name":"Perq access & clsr fem art","description":"Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 french or larger), including ultrasound guidance, when performed, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58660","name":"Laparoscopy lysis","description":"Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00914","name":"Anes trurl px rescj prst8","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of prostate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33922","name":"Transect pulmonary artery","description":"Transection of pulmonary artery with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93985","name":"Dup-scan hemo compl bi std","description":"Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33966","name":"Ecmo/ecls rmvl prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87520","name":"Hepatitis c rna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis c, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36902","name":"Intro cath dialysis circuit","description":"Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":647.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72010","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27560","name":"Treat kneecap dislocation","description":"Closed treatment of patellar dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72270","name":"Myelogphy 2/> spine regions","description":"Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28240","name":"Release of big toe","description":"Tenotomy, lengthening, or release, abductor hallucis muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59410","name":"Obstetrical care","description":"Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00214","name":"Anes icr px burr holes","description":"Anesthesia for intracranial procedures; burr holes, including ventriculography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2058","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62165","name":"Remove pituit tumor w/scope","description":"Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15771","name":"Grfg autol fat lipo 50 cc/<","description":"Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95830","name":"Insert electrodes for eeg","description":"Insertion by physician or other qualified health care professional of sphenoidal electrodes for electroencephalographic (eeg) recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4081","name":"Enteral ng tubing w/ stylet","description":"Nasogastric tubing with stylet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88162","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52301","name":"Cystoscopy and treatment","description":"Cystourethroscopy; with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82654","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0039","name":"Leg strap h style each","description":"Leg strap, h style, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96120","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1701","name":"Repl cushions for jaw motion","description":"Replacement cushions for jaw motion rehabilitation system, pkg. of 6","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30468","name":"Rpr nsl vlv collapse w/implt","description":"Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5677","name":"Bk knee joints polycentric p","description":"Additions to lower extremity, below knee, knee joints, polycentric, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2370","name":"Patten bottom","description":"Addition to lower extremity, patten bottom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51900","name":"Repair bladder/vagina lesion","description":"Closure of vesicovaginal fistula, abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27334","name":"Remove knee joint lining","description":"Arthrotomy, with synovectomy, knee; anterior or posterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":577.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2760","name":"Scratch resistant coating","description":"Scratch resistant coating, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47542","name":"Dilate biliary duct/ampulla","description":"Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42180","name":"Repair lac palate<2 cm","description":"Repair, laceration of palate; up to 2 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51045","name":"Incise bladder/drain ureter","description":"Cystotomy, with insertion of ureteral catheter or stent (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81314","name":"Pdgfra gene","description":"Pdgfra (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [gist]), gene analysis, targeted sequence analysis (eg, exons 12, 18)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":164.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4465","name":"Non-elastic extremity binder","description":"Non-elastic binder for extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5816","name":"Endo knee-shin polyc mch sta","description":"Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37186","name":"Sec art thrombectomy add-on","description":"Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5682","name":"Bk thigh lacer glut/ischia m","description":"Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63091","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63194","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1455.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88381","name":"Microdissection manual","description":"Microdissection (ie, sample preparation of microscopically identified target); manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27818","name":"Treatment of ankle fracture","description":"Closed treatment of trimalleolar ankle fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":406.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41017","name":"Drainage of mouth lesion","description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submandibular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":347.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62294","name":"Injection into spinal artery","description":"Injection procedure, arterial, for occlusion of arteriovenous malformation, spinal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48102","name":"Needle biopsy pancreas","description":"Biopsy of pancreas, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35211","name":"Rpr blvsl dir ntrathrc w/byp","description":"Repair blood vessel, direct; intrathoracic, with bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1205.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34830","name":"Open aortic tube prosth repr","description":"Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1558.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87591","name":"N.gonorrhoeae dna amp prob","description":"Infectious agent detection by nucleic acid (dna or rna); neisseria gonorrhoeae, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87143","name":"Culture typing glc/hplc","description":"Culture, typing; gas liquid chromatography (glc) or high pressure liquid chromatography (hplc) method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87071","name":"Culture aerobic quant other","description":"Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15151","name":"Tis cltr skn agrft t/a/l add","description":"Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42226","name":"Lengthening of palate","description":"Lengthening of palate, and pharyngeal flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":686.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75840","name":"Vein x-ray adrenal gland","description":"Venography, adrenal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6199","name":"Alginate drsg wound filler","description":"Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82570","name":"Assay of urine creatinine","description":"Creatinine; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86632","name":"Chlamydia igm antibody","description":"Antibody; chlamydia, igm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35761","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":326.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59410","name":"Obstetrical care","description":"Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":918.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33320","name":"Repair major blood vessel(s)","description":"Suture repair of aorta or great vessels; without shunt or cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5200","name":"Percutaneous catheter anchor","description":"Percutaneous catheter/tube anchoring device, adhesive skin attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15756","name":"Free myo/skin flap microvasc","description":"Free muscle or myocutaneous flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62270","name":"Dx lmbr spi pnxr","description":"Spinal puncture, lumbar, diagnostic;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30100","name":"Intranasal biopsy","description":"Biopsy, intranasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42100","name":"Biopsy roof of mouth","description":"Biopsy of palate, uvula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30410","name":"Reconstruction of nose","description":"Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1060.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26075","name":"Explore/treat finger joint","description":"Arthrotomy, with exploration, drainage, or removal of loose or foreign body; metacarpophalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90476","name":"Adenovirus vaccine type 4","description":"Adenovirus vaccine, type 4, live, for oral use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33953","name":"Ecmo/ecls insj prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58146","name":"Myomectomy abdom complex","description":"Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g, abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64605","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":515.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22855","name":"Removal anterior instrmj","description":"Removal of anterior instrumentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":982.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0105","name":"Colorectal scrn; hi risk ind","description":"Colorectal cancer screening; colonoscopy on individual at high risk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","53"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77280","name":"Ther rad simulaj field smpl","description":"Therapeutic radiology simulation-aided field setting; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99460","name":"Init nb em per day hosp","description":"Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21616","name":"Exc 1st&/crv rib w/sympth","description":"Excision first and/or cervical rib; with sympathectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":626.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33964","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97763","name":"Orthc/prostc mgmt sbsq enc","description":"Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0956","name":"W/c lateral trunk/hip suppor","description":"Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78800","name":"Rp loclzj tum 1 area 1 d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (eg, head, neck, chest, pelvis), single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24535","name":"Cltx sprcndylr humeral fx w/","description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99420","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83987","name":"Exhaled breath condensate","description":"Ph; exhaled breath condensate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23540","name":"Cltx acromclav dislc wo mnpj","description":"Closed treatment of acromioclavicular dislocation; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78306","name":"Bone imaging whole body","description":"Bone and/or joint imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52351","name":"Cystouretero & or pyeloscope","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":243.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7046","name":"Repl water chamber, pap dev","description":"Water chamber for humidifier, used with positive airway pressure device, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25515","name":"Optx radial shaft fracture","description":"Open treatment of radial shaft fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":562.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0075T","name":"Perq stent/chest vert art","description":"Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95144","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single dose vial(s) (specify number of vials)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65260","name":"Remove foreign body from eye","description":"Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior route","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":584.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47400","name":"Incision of liver duct","description":"Hepaticotomy or hepaticostomy with exploration, drainage, or removal of calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1810.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29530","name":"Strapping of knee","description":"Strapping; knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82784","name":"Assay iga/igd/igg/igm each","description":"Gammaglobulin (immunoglobulin); iga, igd, igg, igm, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78350","name":"Bone mineral single photon","description":"Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29830","name":"Elbow arthroscopy","description":"Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3807","name":"Whfo w/o joints pre cst","description":"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20100","name":"Expl pentrg wound neck","description":"Exploration of penetrating wound (separate procedure); neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97164","name":"Pt re-eval est plan care","description":"Re-evaluation of physical therapy established plan of care, requiring these components: an examination including a review of history and use of standardized tests and measures is required; and revised plan of care using a standardized patient assessment instrument and/or measurable assessment of fun","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32421","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3320","name":"Shoe lift elev heel/sole cor","description":"Lift, elevation, heel and sole, cork, per inch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5362","name":"Speech screening","description":"Speech screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31368","name":"Partial removal of larynx","description":"Laryngectomy; subtotal supraglottic, with radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1822.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6536","name":"Gc stocking full lngth 18-30","description":"Gradient compression stocking, full length/chap style, 18-30 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35102","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels (common, hypogastric, external)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31800","name":"Repair of windpipe injury","description":"Suture of tracheal wound or injury; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5083","name":"Stoma absorptive cover","description":"Continent device, stoma absorptive cover for continent stoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01937","name":"Anes drg/aspir crv/thrc","description":"Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93293","name":"Pm phone r-strip device eval","description":"Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46070","name":"Incision anal septum infant","description":"Incision, anal septum (infant)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91132","name":"Electrogastrography","description":"Electrogastrography, diagnostic, transcutaneous;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77022","name":"Mri gdn parnchyma tiss abltj","description":"Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62365","name":"Remove spine infusion device","description":"Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5063","name":"Drain ostomy pouch w/flange","description":"Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5706","name":"Custom shape cvr knee disart","description":"Custom shaped protective cover, knee disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7008","name":"Pediatric electric hand","description":"Electric hand, switch or myoelectric, controlled, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52235","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; medium bladder tumor(s) (2.0 to 5.0 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52325","name":"Cystoscopy stone removal","description":"Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":257.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86337","name":"Insulin antibodies","description":"Insulin antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76150","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72198","name":"Mr angio pelvis w/o & w/dye","description":"Magnetic resonance angiography, pelvis, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74019","name":"Radex abdomen 2 views","description":"Radiologic examination, abdomen; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33694","name":"Cmp rpr tof wo plm atrs ptch","description":"Complete repair tetralogy of fallot without pulmonary atresia; with transannular patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1698.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0256","name":"Hospital bed var ht w/o matt","description":"Hospital bed, variable height, hi-lo, with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26255","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":649.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83930","name":"Assay of blood osmolality","description":"Osmolality; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01522","name":"Anes px vn lwr leg ven thrmb","description":"Anesthesia for procedures on veins of lower leg; venous thrombectomy, direct or with catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54385","name":"Repair penis","description":"Plastic operation on penis for epispadias distal to external sphincter; with incontinence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":752.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93564","name":"Njx cgen car cath slctv opac","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21138","name":"Rdctj forehead cntrg&prostc","description":"Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":769.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43213","name":"Esophagoscopy retro balloon","description":"Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":950.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78191","name":"Platelet survival study","description":"Platelet survival study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99380","name":"Nursing fac care supervision","description":"Supervision of a nursing facility patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, comm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52341","name":"Cysto w/ureter stricture tx","description":"Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30905","name":"Control of nosebleed","description":"Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":255.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92987","name":"Revision of mitral valve","description":"Percutaneous balloon valvuloplasty; mitral valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1443.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43848","name":"Revj open gstr rstcv px","description":"Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1621.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21432","name":"Optx cranfcl sep w/wiring","description":"Open treatment of craniofacial separation (lefort iii type); with wiring and/or internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1960","name":"Afo pos solid ank plastic mo","description":"Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15834","name":"Exc excessive skin hip","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23076","name":"Exc shoulder tum deep < 5 cm","description":"Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20612","name":"Aspirate/inj ganglion cyst","description":"Aspiration and/or injection of ganglion cyst(s) any location","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43300","name":"Repair of esophagus","description":"Esophagoplasty (plastic repair or reconstruction), cervical approach; without repair of tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51715","name":"Endoscopic injection/implant","description":"Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46706","name":"Repr of anal fistula w/glue","description":"Repair of anal fistula with fibrin glue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95165","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99378","name":"Hospice care supervision","description":"Supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95929","name":"C motor evoked lwr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93618","name":"Indctj arrhythmia elec pacg","description":"Induction of arrhythmia by electrical pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99375","name":"Home health care supervision","description":"Supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (eg, alzheimers facility) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0443T","name":"R-t spctrl alys prst8 tiss","description":"Real-time spectral analysis of prostate tissue by fluorescence spectroscopy, including imaging guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5697","name":"Ak/knee disartic pelvic band","description":"Addition to lower extremity, above knee or knee disarticulation, pelvic band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2210","name":"Wheelchair bearings","description":"Wheelchair accessory, bearings, any type, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72020","name":"X-ray exam of spine 1 view","description":"Radiologic examination, spine, single view, specify level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0781","name":"External ambulatory infus pu","description":"Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2820","name":"Soft interface below knee se","description":"Addition to lower extremity orthosis, soft interface for molded plastic, below knee section","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84402","name":"Assay of free testosterone","description":"Testosterone; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61543","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for partial or subtotal (functional) hemispherectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1993.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35535","name":"Art byp grft hepatorenal","description":"Bypass graft, with vein; hepatorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1684.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67121","name":"Remove eye implant material","description":"Removal of implanted material, posterior segment; intraocular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":543.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74410","name":"Urography nfs drip&/bolus","description":"Urography, infusion, drip technique and/or bolus technique;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77600","name":"Hyperthermia ext gen supfc","description":"Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42205","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":785.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41510","name":"Tongue to lip surgery","description":"Suture of tongue to lip for micrognathia (douglas type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4208","name":"3 cc sterile syringe&needle","description":"Syringe with needle, sterile 3 cc, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00770","name":"Anes px maj abd blood vessel","description":"Anesthesia for all procedures on major abdominal blood vessels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21240","name":"Reconstruction of jaw joint","description":"Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":857.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46230","name":"Removal of anal tags","description":"Excision of multiple external papillae or tags, anus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64760","name":"Incision of vagus nerve","description":"Transection or avulsion of; vagus nerve (vagotomy), abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31780","name":"Reconstruct windpipe","description":"Excision tracheal stenosis and anastomosis; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29845","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; synovectomy, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":487.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41130","name":"Partial removal of tongue","description":"Glossectomy; hemiglossectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0951","name":"Loop heel","description":"Heel loop/holder, any type, with or without ankle strap, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28022","name":"Exploration of foot joint","description":"Arthrotomy, including exploration, drainage, or removal of loose or foreign body; metatarsophalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00402","name":"Anes integ sys rcnstv breast","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; reconstructive procedures on breast (eg, reduction or augmentation mammoplasty, muscle flaps)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59515","name":"Cesarean delivery","description":"Cesarean delivery only; including postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0303","name":"Hosp bed hvy dty xtra wide","description":"Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6216","name":"Non-sterile gauze<=16 sq in","description":"Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54057","name":"Laser surg penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3975","name":"Sewhfo cap design w/o jnt cf","description":"Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49250","name":"Excision of umbilicus","description":"Umbilectomy, omphalectomy, excision of umbilicus (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25430","name":"Vasc graft into carpal bone","description":"Insertion of vascular pedicle into carpal bone (eg, hori procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23520","name":"Cltx strnclav dislc w/o mnpj","description":"Closed treatment of sternoclavicular dislocation; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50234","name":"Removal of kidney & ureter","description":"Nephrectomy with total ureterectomy and bladder cuff; through same incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96936","name":"Rcm i&r only ea addl lesion","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; interpretation and report only, each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64550","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61751","name":"Brain biopsy w/ct/mr guide","description":"Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion; with computed tomography and/or magnetic resonance guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76940","name":"Us guide tissue ablation","description":"Ultrasound guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59414","name":"Deliver placenta","description":"Delivery of placenta (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26035","name":"Decompress fingers/hand","description":"Decompression fingers and/or hand, injection injury (eg, grease gun)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":723.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0010","name":"Admin hepatitis b vaccine","description":"Administration of hepatitis b vaccine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0454","name":"Md document visit by npp","description":"Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33475","name":"Replacement pulmonary valve","description":"Replacement, pulmonary valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2024.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96361","name":"Hydrate iv infusion add-on","description":"Intravenous infusion, hydration; each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8415","name":"Sheath upper limb","description":"Prosthetic sheath, upper limb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64455","name":"Njx aa&/strd pltr com dg nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, mortons neuroma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0399","name":"Home sleep test/type 3 porta","description":"Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77778","name":"Apply interstit radiat compl","description":"Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93462","name":"L hrt cath trnsptl puncture","description":"Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":223.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35103","name":"Repair artery rupture aorta","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, hypogastric, external)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2500","name":"Thi/glut/ischia wgt bearing","description":"Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52310","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5560","name":"Prep ak ischial plast molded","description":"Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1127.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28605","name":"Treat foot dislocation","description":"Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":277.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44950","name":"Appendectomy","description":"Appendectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35526","name":"Art byp grft aor/carot/innom","description":"Bypass graft, with vein; aortosubclavian, aortoinnominate, or aortocarotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63282","name":"Bx/exc idrl spine lesn lmbr","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1802.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64864","name":"Repair of facial nerve","description":"Suture of facial nerve; extracranial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94010","name":"Breathing capacity test","description":"Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46750","name":"Repair of anal sphincter","description":"Sphincteroplasty, anal, for incontinence or prolapse; adult","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65270","name":"Repair of eye wound","description":"Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85270","name":"Clot factor xi pta","description":"Clotting; factor xi (pta)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51785","name":"Anal/urinary muscle study","description":"Needle electromyography studies (emg) of anal or urethral sphincter, any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01830","name":"Anes arthr/ndsc wrst/hnd nos","description":"Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6895","name":"Custom glove for term device","description":"Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33720","name":"Repair of heart defect","description":"Repair sinus of valsalva aneurysm, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1342.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19288","name":"Perq dev breast add mr guide","description":"Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68040","name":"Treatment of eyelid lesions","description":"Expression of conjunctival follicles (eg, for trachoma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86901","name":"Blood typing serologic rh(d)","description":"Blood typing, serologic; rh (d)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52287","name":"Cystoscopy chemodenervation","description":"Cystourethroscopy, with injection(s) for chemodenervation of the bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76801","name":"Ob us < 14 wks single fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65870","name":"Incise inner eye adhesions","description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66183","name":"Insert ant drainage device","description":"Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59515","name":"Cesarean delivery","description":"Cesarean delivery only; including postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1130.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70015","name":"Contrast x-ray of brain","description":"Cisternography, positive contrast, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58563","name":"Hysteroscopy ablation","description":"Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1219.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75820","name":"Vein x-ray arm/leg","description":"Venography, extremity, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9037","name":"Plate pheres leukoredu irrad","description":"Platelets, pheresis, leukocytes reduced, irradiated, each unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":919.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0850","name":"Traction stand free standing","description":"Traction stand, free standing, cervical traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74220","name":"X-ray xm esophagus 1cntrst","description":"Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27488","name":"Removal of knee prosthesis","description":"Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1016.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19110","name":"Nipple exploration","description":"Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":316.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77412","name":"Radiation tx delivery lvl 3","description":"Radiation treatment delivery; level 3, multiple isocenters with photon therapy (eg, 2d, 3d, or imrt) or a single-isocenter photon therapy (eg, 3d or imrt) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21077","name":"Impres&prep orbital prosth","description":"Impression and custom preparation; orbital prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27443","name":"Revision of knee joint","description":"Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":686.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43761","name":"Reposition gastrostomy tube","description":"Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95807","name":"Sleep study attended","description":"Sleep study, simultaneous recording of ventilation, respiratory effort, ecg or heart rate, and oxygen saturation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0486","name":"Tlso rigidlined cust fab two","description":"Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlappin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":942.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01160","name":"Anes clsd px symph pub/si jt","description":"Anesthesia for closed procedures involving symphysis pubis or sacroiliac joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83527","name":"Assay of insulin","description":"Insulin; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84460","name":"Alanine amino (alt) (sgpt)","description":"Transferase; alanine amino (alt) (sgpt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53665","name":"Dilation of urethra","description":"Dilation of female urethra, general or conduction (spinal) anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44211","name":"Lap colectomy w/proctectomy","description":"Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (s or j), with loop ileostomy, includes rectal mucosectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57100","name":"Biopsy vaginal mucosa simple","description":"Biopsy of vaginal mucosa; simple (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21280","name":"Medial canthopexy","description":"Medial canthopexy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82759","name":"Assay of rbc galactokinase","description":"Galactokinase, rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78264","name":"Gastric emptying img study","description":"Gastric emptying imaging study (eg, solid, liquid, or both);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0626","name":"Lo sag rig pnl stays pre cst","description":"Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabrica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73725","name":"Mr ang lwr ext w or w/o dye","description":"Magnetic resonance angiography, lower extremity, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":305.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0113","name":"Pinworm examinations","description":"Pinworm examinations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4262","name":"Temporary tear duct plug","description":"Temporary, absorbable lacrimal duct implant, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15731","name":"Forehead flap w/vasc pedicle","description":"Forehead flap with preservation of vascular pedicle (eg, axial pattern flap, paramedian forehead flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":704.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76940","name":"Us guide tissue ablation","description":"Ultrasound guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96203","name":"Mlt fam grp bhv train ea add","description":"Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of paren","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27230","name":"Treat thigh fracture","description":"Closed treatment of femoral fracture, proximal end, neck; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0113","name":"Pinworm examinations","description":"Pinworm examinations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72126","name":"Ct neck spine w/dye","description":"Computed tomography, cervical spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86689","name":"Htlv/hiv confirmj antibody","description":"Antibody; htlv or hiv antibody, confirmatory test (eg, western blot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71250","name":"Ct thorax dx c-","description":"Computed tomography, thorax, diagnostic; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67027","name":"Implant eye drug system","description":"Implantation of intravitreal drug delivery system (eg, ganciclovir implant), includes concomitant removal of vitreous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22852","name":"Remove spine fixation device","description":"Removal of posterior segmental instrumentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27524","name":"Treat kneecap fracture","description":"Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67700","name":"Blepharotomy drg absc eyelid","description":"Blepharotomy, drainage of abscess, eyelid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85130","name":"Chromogenic substrate assay","description":"Chromogenic substrate assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77047","name":"Mri breast c- bilateral","description":"Magnetic resonance imaging, breast, without contrast material; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67500","name":"Inject/treat eye socket","description":"Retrobulbar injection; medication (separate procedure, does not include supply of medication)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61501","name":"Craniectomy f/osteomyelitis","description":"Craniectomy; for osteomyelitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":998.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36468","name":"Njx sclrsnt spider veins","description":"Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20938","name":"Sp bone agrft struct add-on","description":"Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73000","name":"X-ray exam of collar bone","description":"Radiologic examination; clavicle, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7505","name":"Hmes or trach valve housing","description":"Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87273","name":"Herpes simplex 2 ag if","description":"Infectious agent antigen detection by immunofluorescent technique; herpes simplex virus type 2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77262","name":"Ther radiology tx plng intrm","description":"Therapeutic radiology treatment planning; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23030","name":"I&d shoulder deep absc/hmtma","description":"Incision and drainage, shoulder area; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21127","name":"Augmentation mndblr b1 grf","description":"Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3259.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66850","name":"Removal of lens material","description":"Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0271","name":"Mattress innerspring","description":"Mattress, innerspring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38724","name":"Removal of lymph nodes neck","description":"Cervical lymphadenectomy (modified radical neck dissection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59050","name":"Fetal monitor w/report","description":"Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35901","name":"Excision graft neck","description":"Excision of infected graft; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87550","name":"Mycobacteria dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria species, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24332","name":"Tenolysis triceps","description":"Tenolysis, triceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27275","name":"Manipulation of hip joint","description":"Manipulation, hip joint, requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63707","name":"Repair spinal fluid leakage","description":"Repair of dural/cerebrospinal fluid leak, not requiring laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52285","name":"Cystoscopy and treatment","description":"Cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp(s) of urethra, bladder neck, and/or ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":262.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4392","name":"Urinary pouch w st wear barr","description":"Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0635","name":"Lso sagit rigid panel prefab","description":"Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pr","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":474.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2511","name":"Cntct toric prism ballast","description":"Contact lens, gas permeable, toric, prism ballast, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90824","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44146","name":"Partial removal of colon","description":"Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57265","name":"Cmbn ap colprhy w/ntrcl rpr","description":"Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed; with enterocele repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":556.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43261","name":"Endo cholangiopancreatograph","description":"Endoscopic retrograde cholangiopancreatography (ercp); with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":259.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0578T","name":"Rem interrog dev icds phys","description":"Interrogation device evaluation(s) (remote), up to 90 days, substernal lead implantable cardioverter-defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0877","name":"Pwc gp4 std sing pow opt s/b","description":"Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39541","name":"Repair of diaphragm hernia","description":"Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":819.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27161","name":"Incision of neck of femur","description":"Osteotomy, femoral neck (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1033.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95070","name":"Inhlj brncl challenge tstg","description":"Inhalation bronchial challenge testing (not including necessary pulmonary function tests), with histamine, methacholine, or similar compounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33413","name":"Replacement of aortic valve","description":"Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (ross procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59510","name":"Cesarean delivery","description":"Routine obstetric care including antepartum care, cesarean delivery, and postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58925","name":"Removal of ovarian cyst(s)","description":"Ovarian cystectomy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6001","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84484","name":"Assay of troponin quant","description":"Troponin, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4631","name":"Afo, walk boot type, cus fab","description":"Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49082","name":"Abd paracentesis","description":"Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0398","name":"Home sleep test/type 2 porta","description":"Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76981","name":"Use parenchyma","description":"Ultrasound, elastography; parenchyma (eg, organ)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82252","name":"Fecal bilirubin test","description":"Bilirubin; feces, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20103","name":"Expl pentrg wound extremity","description":"Exploration of penetrating wound (separate procedure); extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":477.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26494","name":"Hand tendon/muscle transfer","description":"Opponensplasty; hypothenar muscle transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":679.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43274","name":"Ercp duct stent placement","description":"Endoscopic retrograde cholangiopancreatography (ercp); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31081","name":"Removal of frontal sinus","description":"Sinusotomy frontal; obliterative, without osteoplastic flap, coronal incision (includes ablation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":849.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6945","name":"Elbow disart myoelectronic c","description":"Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95836","name":"Ecog impltd brn npgt <30 d","description":"Electrocorticogram from an implanted brain neurostimulator pulse generator/transmitter, including recording, with interpretation and written report, up to 30 days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99465","name":"Nb resuscitation","description":"Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88361","name":"Tumor immunohistochem/comput","description":"Morphometric analysis, tumor immunohistochemistry (eg, her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; using computer-assisted technology","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86332","name":"Immune complex assay","description":"Immune complex assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57456","name":"Endocerv curettage w/scope","description":"Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4036","name":"Enteral feed sup kit grav by","description":"Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85013","name":"Spun microhematocrit","description":"Blood count; spun microhematocrit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35483","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":441.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49525","name":"Repair ing hernia sliding","description":"Repair inguinal hernia, sliding, any age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":477.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28192","name":"Removal of foot foreign body","description":"Removal of foreign body, foot; deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83735","name":"Assay of magnesium","description":"Magnesium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00794","name":"Anes iper upr abd pncrtect","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; pancreatectomy, partial or total (eg, whipple procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45392","name":"Colonoscopy w/endoscopic fnb","description":"Colonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73650","name":"X-ray exam of heel","description":"Radiologic examination; calcaneus, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1050","name":"Sternal pad","description":"Addition to ctlso or scoliosis orthosis, sternal pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31613","name":"Tracheostoma revj simple","description":"Tracheostoma revision; simple, without flap rotation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72127","name":"Ct neck spine w/o & w/dye","description":"Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39400","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":431.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01214","name":"Anes open px tot hip arthrp","description":"Anesthesia for open procedures involving hip joint; total hip arthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27386","name":"Repair/graft of thigh muscle","description":"Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0460","name":"Tlso 2 shl symphys-stern cst","description":"Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34203","name":"Removal of leg artery clot","description":"Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73560","name":"X-ray exam of knee 1 or 2","description":"Radiologic examination, knee; 1 or 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35621","name":"Bpg axillary-femoral","description":"Bypass graft, with other than vein; axillary-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q4038","name":"Cast sup shrt leg fiberglass","description":"Cast supplies, short leg cast, adult (11 years +), fiberglass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19084","name":"Bx breast add lesion us imag","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7031","name":"Replacement facemask interfa","description":"Face mask interface, replacement for full face mask, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78610","name":"Brain flow imaging only","description":"Brain imaging, vascular flow only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28304","name":"Incision of midfoot bones","description":"Osteotomy, tarsal bones, other than calcaneus or talus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":670.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6535","name":"Gc stocking thighlngth 40+","description":"Gradient compression stocking, thigh length, 40 mmhg or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35531","name":"Art byp grft aorcel/aormesen","description":"Bypass graft, with vein; aortoceliac or aortomesenteric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1723.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0986","name":"Man w/c powr assist syst","description":"Manual wheelchair accessory, power assist system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78598","name":"Lung perf&ventilat diferentl","description":"Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38510","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, deep cervical node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95928","name":"C motor evoked uppr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); upper limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85557","name":"Rbc osmotic fragility","description":"Osmotic fragility, rbc; incubated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95720","name":"Eeg phy/qhp ea incr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of eeg recording, interpretation and report after each 24-hour period; w","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81165","name":"Brca1 gene full seq alys","description":"Brca1 (brca1, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75571","name":"Ct hrt w/o dye w/ca test","description":"Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11970","name":"Rplcmt tiss xpndr perm implt","description":"Replacement of tissue expander with permanent implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17283","name":"Dstr mal ls f/e/e/n/l/m2.1-3","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33237","name":"Remove electrode/thoracotomy","description":"Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":721.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92933","name":"Prq trlml c athrc st angiop1","description":"Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed, single major coronary artery and/or its branch(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":532.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25820","name":"Arthrd wrist lmtd w/o b1 grf","description":"Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94775","name":"Ped home apnea mntr att only","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitor attachment only (includes hook-up, initiation of recording and disconnection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15340","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92540","name":"Basic vestibular evaluation","description":"Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64408","name":"Njx aa&/strd vagus nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; vagus nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54522","name":"Orchiectomy partial","description":"Orchiectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":476.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26565","name":"Correct metacarpal flaw","description":"Osteotomy; metacarpal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":573.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66150","name":"Glaucoma surgery","description":"Fistulization of sclera for glaucoma; trephination with iridectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53080","name":"Drainage of urinary leakage","description":"Drainage of perineal urinary extravasation; uncomplicated (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0486","name":"Tlso rigidlined cust fab two","description":"Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlappin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64624","name":"Dstrj nulyt agt gnclr nrv","description":"Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95134","name":"Immntx 5 sting insects","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 5 stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0148T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19286","name":"Perq dev breast add us imag","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33019","name":"Perq prcrd drg insj cath ct","description":"Pericardial drainage with insertion of indwelling catheter, percutaneous, including ct guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2102","name":"Singl visn sphere 7.12-20.00","description":"Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28635","name":"Treat toe dislocation","description":"Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83785","name":"Assay of manganese","description":"Manganese","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0970","name":"Tlso corset front","description":"Tlso, corset front","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51590","name":"Remove bladder/revise tract","description":"Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47350","name":"Repair liver wound","description":"Management of liver hemorrhage; simple suture of liver wound or injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1138.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50540","name":"Revision of horseshoe kidney","description":"Symphysiotomy for horseshoe kidney with or without pyeloplasty and/or other plastic procedure, unilateral or bilateral (1 operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":927.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32160","name":"Open chest heart massage","description":"Thoracotomy; with cardiac massage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":632.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77316","name":"Brachytx isodose plan simple","description":"Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5651","name":"Ak flex inner socket ext fra","description":"Addition to lower extremity, above knee, flexible inner socket, external frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":596.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33231","name":"Insrt pulse gen w/mult leads","description":"Insertion of implantable defibrillator pulse generator only; with existing multiple leads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0339","name":"Robot lin-radsurg com, first","description":"Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0604","name":"Repl batt lithium 3.6 v","description":"Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0479T","name":"Fxjl abl lsr 1st 100 sq cm","description":"Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or part thereof, or 1% of body surface area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27259","name":"Treat hip dislocation","description":"Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shortening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45126","name":"Pelvic exenteration","description":"Pelvic exenteration for colorectal malignancy, with proctectomy (with or without colostomy), with removal of bladder and ureteral transplantations, and/or hysterectomy, or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), or any combination thereof","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42320","name":"Drainage of salivary gland","description":"Drainage of abscess; submaxillary, external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24320","name":"Tenoplasty elbow to sho 1","description":"Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder, single (seddon-brookes type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44386","name":"Endoscopy bowel pouch/biop","description":"Endoscopic evaluation of small intestinal pouch (eg, kock pouch, ileal reservoir [s or j]); with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28261","name":"Revision of foot tendon","description":"Capsulotomy, midfoot; with tendon lengthening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1007.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97169","name":"Athletic trn eval low cmplx","description":"Athletic training evaluation, low complexity, requiring these components: a history and physical activity profile with no comorbidities that affect physical activity; an examination of affected body area and other symptomatic or related systems addressing 1-2 elements from any of the following: body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50976","name":"Ureter endoscopy & treatment","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":376.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93024","name":"Ergonovine provocation test","description":"Ergonovine provocation test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77315","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93352","name":"Admin ecg contrast agent","description":"Use of echocardiographic contrast agent during stress echocardiography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95974","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84588","name":"Assay of vasopressin","description":"Vasopressin (antidiuretic hormone, adh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0358T","name":"Bia whole body","description":"Bioelectrical impedance analysis whole body composition assessment, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9485","name":"Remote e/m new pt 60mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7186","name":"Electron elbow child switch","description":"Electronic elbow, child, variety village or equal, switch controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75561","name":"Cardiac mri for morph w/dye","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2320","name":"Lens trifocal add over 3.25d","description":"Trifocal add over 3.25d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75807","name":"Lymph vessel x-ray trunk","description":"Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1840","name":"Adj shoulder ext/flex device","description":"Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35682","name":"Composite byp grft 2 veins","description":"Bypass graft; autogenous composite, 2 segments of veins from 2 locations (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":312.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0667","name":"Seg pneumatic appl full leg","description":"Segmental pneumatic appliance for use with pneumatic compressor, full leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0271","name":"Group mnt 2 or more 30 mins","description":"Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5510","name":"Compression form shoe insert","description":"For diabetics only, direct formed, compression molded to patients foot without external heat source, multiple-density insert(s) prefabricated, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43284","name":"Laps esophgl sphnctr agmntj","description":"Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39220","name":"Resect mediastinal tumor","description":"Resection of mediastinal tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6600","name":"Polycentric hinge pair","description":"Upper extremity additions, polycentric hinge, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01760","name":"Anes opn/arthr elb tot rplct","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; total elbow replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67810","name":"Incal bx eyelid skn lid mrgn","description":"Incisional biopsy of eyelid skin including lid margin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3900","name":"Hinge extension/flex wrist/f","description":"Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":590.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57120","name":"Colpocleisis le fort type","description":"Colpocleisis (le fort type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":332.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69005","name":"Drg xtrnl ear absc/hem comp","description":"Drainage external ear, abscess or hematoma; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85348","name":"Coagulation time otr method","description":"Coagulation time; other methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91133","name":"Electrogastrography w/test","description":"Electrogastrography, diagnostic, transcutaneous; with provocative testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49000","name":"Exploration of abdomen","description":"Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61601","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; intradural, including dural repair, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0484","name":"Non-elec oscillatory pep dvc","description":"Oscillatory positive expiratory pressure device, non-electric, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2005","name":"Post-d/c h vst new pt 75 m","description":"Extensive (75 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59856","name":"Induced ab 1+vag supp d&c","description":"Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26675","name":"Treat hand dislocation","description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84163","name":"Pappa serum","description":"Pregnancy-associated plasma protein-a (papp-a)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15730","name":"Mdfc flap w/prsrv vasc pedcl","description":"Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":937.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95910","name":"Nrv cndj test 7-8 studies","description":"Nerve conduction studies; 7-8 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92286","name":"Ant sgm img i&r speclr mic","description":"Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28455","name":"Tx tarsal b1 fx w/mnpj each","description":"Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62180","name":"Establish brain cavity shunt","description":"Ventriculocisternostomy (torkildsen type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25290","name":"Incise wrist/forearm tendon","description":"Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28292","name":"Cor hlx vlgs rsc prx phlx bs","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28262","name":"Revision of foot and ankle","description":"Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot deformity)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1168.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84586","name":"Assay of vip","description":"Vasoactive intestinal peptide (vip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00752","name":"Anes hrna rpr lmbr&vnt&/dehs","description":"Anesthesia for hernia repairs in upper abdomen; lumbar and ventral (incisional) hernias and/or wound dehiscence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5113","name":"Latex leg strap","description":"Leg strap; latex, replacement only, per set","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27709","name":"Osteotomy tibia & fibula","description":"Osteotomy; tibia and fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28405","name":"Cltx calcaneal fx w/mnpj","description":"Closed treatment of calcaneal fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15936","name":"Exc sac pr ulc prep mus flap","description":"Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":589.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74712","name":"Mri fetal sngl/1st gestation","description":"Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90970","name":"Esrd svc pr day pt 20+","description":"End-stage renal disease (esrd) related services for dialysis less than a full month of service, per day; for patients 20 years of age and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80100","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22905","name":"Rad resect abd tumor 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33519","name":"Cabg artery-vein three","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93247","name":"Ext ecg>7d<15d scan a/r","description":"External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; scanning analysis with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0660","name":"Pneumatic appliance full leg","description":"Non-segmental pneumatic appliance for use with pneumatic compressor, full leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"C1300","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5830","name":"Endo knee-shin pneum/swg pha","description":"Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15757","name":"Free skin flap microvasc","description":"Free skin flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92235","name":"Fluorescein angrph mltiframe","description":"Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93271","name":"Ecg/monitoring and analysis","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; transmission and analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":164.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77001","name":"Fluoroguide for vein device","description":"Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic su","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94645","name":"Cont inhlj tx each addl hour","description":"Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0109","name":"Diab manage trn ind/group","description":"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4533","name":"Youth size brief/diaper","description":"Youth sized disposable incontinence product, brief/diaper, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0483","name":"Monitor elec vad, rep","description":"Monitor/display module for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01958","name":"Anes xtrnl cephalic version","description":"Anesthesia for external cephalic version procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82951","name":"Glucose tolerance test (gtt)","description":"Glucose; tolerance test (gtt), 3 specimens (includes glucose)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26025","name":"Drainage of palm bursa","description":"Drainage of palmar bursa; single, bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0140","name":"Cervical semi-rigid adjustab","description":"Cervical, semi-rigid, adjustable (plastic collar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97124","name":"Massage therapy","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43425","name":"Repair esophagus opening","description":"Closure of esophagostomy or fistula; transthoracic or transabdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1193.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5102","name":"Bedside drain btl w/wo tube","description":"Bedside drainage bottle with or without tubing, rigid or expandable, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36002","name":"Pseudoaneurysm injection trt","description":"Injection procedures (eg, thrombin) for percutaneous treatment of extremity pseudoaneurysm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11403","name":"Exc tr-ext b9+marg 2.1-3cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73130","name":"X-ray exam of hand","description":"Radiologic examination, hand; minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21175","name":"Rcnst bfrnt sp orb rm&lw fhd","description":"Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8501","name":"Tracheostomy speaking valve","description":"Tracheostomy speaking valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1226","name":"Manual fully reclining back","description":"Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85810","name":"Blood viscosity examination","description":"Viscosity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74270","name":"X-ray xm colon 1cntrst std","description":"Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92607","name":"Ex for speech device rx 1hr","description":"Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37183","name":"Revision tips","description":"Revision of transvenous intrahepatic portosystemic shunt(s) (tips) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recannulization/dilatation, stent placement and all associated imaging guidance and documentation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5002.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11306","name":"Shave skin lesion 0.6-1.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2036","name":"Kafo plas doub free knee mol","description":"Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1152.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54312","name":"Reconstruction of urethra","description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); greater than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":662.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76776","name":"Us exam k transpl w/doppler","description":"Ultrasound, transplanted kidney, real time and duplex doppler with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22812","name":"Arthrd ant dfrm 8+ vrt sgm","description":"Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1876.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4528","name":"Adult size pull-on xl","description":"Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61558","name":"Excision of skull/sutures","description":"Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); not requiring bone grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1610","name":"Ho frejka cov only pre cst","description":"Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6232","name":"Hydrogel dsg>16<=48 sq in","description":"Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31253","name":"Nsl/sins ndsc total","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86334","name":"Immunofix e-phoresis serum","description":"Immunofixation electrophoresis; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24341","name":"Rpr tdn/musc upr a/e each","description":"Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82435","name":"Assay of blood chloride","description":"Chloride; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82948","name":"Reagent strip/blood glucose","description":"Glucose; blood, reagent strip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28740","name":"Fusion of foot bones","description":"Arthrodesis, midtarsal or tarsometatarsal, single joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00700","name":"Anes px upr ant abd wall nos","description":"Anesthesia for procedures on upper anterior abdominal wall; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53502","name":"Repair of urethra injury","description":"Urethrorrhaphy, suture of urethral wound or injury, female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33617","name":"Repair single ventricle","description":"Repair of complex cardiac anomalies (eg, single ventricle) by modified fontan procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63191","name":"Incise spine accessory nerve","description":"Laminectomy with section of spinal accessory nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23665","name":"Cltx sho dslc fx gr hmrl tbr","description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27181","name":"Treat slipped epiphysis","description":"Open treatment of slipped femoral epiphysis; osteotomy and internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":948.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99487","name":"Cplx chrnc care 1st 60 min","description":"Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96130","name":"Psycl tst eval phys/qhp 1st","description":"Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87428","name":"Sarscov & inf vir a&b ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, sars-cov, s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43248","name":"Egd guide wire insertion","description":"Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65800","name":"Drainage of eye","description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79403","name":"Hematopoietic nuclear tx","description":"Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64716","name":"Revision of cranial nerve","description":"Neuroplasty and/or transposition; cranial nerve (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47460","name":"Incise bile duct sphincter","description":"Transduodenal sphincterotomy or sphincteroplasty, with or without transduodenal extraction of calculus (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66762","name":"Revision of iris","description":"Iridoplasty by photocoagulation (1 or more sessions) (eg, for improvement of vision, for widening of anterior chamber angle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2322","name":"Mult mech switches","description":"Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR","","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75860","name":"Vein x-ray neck","description":"Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28291","name":"Corrj halux rigdus w/implt","description":"Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25035","name":"Inc dp bone crtx f/arm&/wrst","description":"Incision, deep, bone cortex, forearm and/or wrist (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96912","name":"Photochemotherapy puva","description":"Photochemotherapy; psoralens and ultraviolet a (puva)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27397","name":"Transplants of thigh tendons","description":"Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1821","name":"Replacement interface spsd","description":"Replacement soft interface material/cuffs for bi-directional static progressive stretch device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77761","name":"Apply intrcav radiat simple","description":"Intracavitary radiation source application; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92541","name":"Spontaneous nystagmus test","description":"Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84075","name":"Assay alkaline phosphatase","description":"Phosphatase, alkaline;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8610","name":"Ocular implant","description":"Ocular implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37184","name":"Prim art m-thrmbc 1st vsl","description":"Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":989.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42405","name":"Biopsy of salivary gland","description":"Biopsy of salivary gland; incisional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64726","name":"Dcmprn plantar digital nerve","description":"Decompression; plantar digital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47541","name":"Plmt access bil tree sm bwl","description":"Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological superv","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21247","name":"Reconstruct lower jaw bone","description":"Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41828","name":"Excision of gum lesion","description":"Excision of hyperplastic alveolar mucosa, each quadrant (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":272.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35600","name":"Open hrv uxtr art 1 sgm cab","description":"Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5716","name":"Knee-shin exo mech stance ph","description":"Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51020","name":"Cystotomy/cystostomy w/fulg","description":"Cystotomy or cystostomy, with fulguration and/or insertion of radioactive material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26650","name":"Treat thumb fracture","description":"Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (bennett fracture), with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90827","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72125","name":"Ct neck spine w/o dye","description":"Computed tomography, cervical spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60212","name":"Partial thyroid excision","description":"Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":897.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92612","name":"Endoscopy swallow (fees) vid","description":"Flexible endoscopic evaluation of swallowing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87532","name":"Hhv-6 dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); herpes virus-6, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65103","name":"Remove eye/insert implant","description":"Enucleation of eye; with implant, muscles not attached to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49061","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":747.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0444T","name":"1st plmt drug elut oc ins","description":"Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84300","name":"Assay of urine sodium","description":"Sodium; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26030","name":"Drainage of palm bursas","description":"Drainage of palmar bursa; multiple bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69820","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":665.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77263","name":"Ther radiology tx plng cplx","description":"Therapeutic radiology treatment planning; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61055","name":"Injection into brain canal","description":"Cisternal or lateral cervical (c1-c2) puncture; with injection of medication or other substance for diagnosis or treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12004","name":"Rpr s/n/ax/gen/trk7.6-12.5cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29904","name":"Subtalar arthro w/fb rmvl","description":"Arthroscopy, subtalar joint, surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9483","name":"Remote e/m new pt 30mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real tim","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9481","name":"Remote e/m new pt 10mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history;  a problem focused examination; and straightforward medical decision making, furn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49406","name":"Image cath fluid peri/retro","description":"Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":676.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29365","name":"Appl cylinder cast","description":"Application of cylinder cast (thigh to ankle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5105","name":"Urinary suspensory","description":"Urinary suspensory with leg bag, with or without tube, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77073","name":"Bone length studies","description":"Bone length studies (orthoroentgenogram, scanogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36600","name":"Withdrawal of arterial blood","description":"Arterial puncture, withdrawal of blood for diagnosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0607","name":"Repl batt for aed","description":"Replacement battery for automated external defibrillator, garment type only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81233","name":"Btk gene common variants","description":"Btk (brutons tyrosine kinase) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, c481s, c481r, c481f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1195","name":"Wheelchair amputee heavy dut","description":"Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70540","name":"Mri orbit/face/neck w/o dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1810","name":"Ko elastic with joints","description":"Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87641","name":"Mr-staph dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); staphylococcus aureus, methicillin resistant, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35870","name":"Repair vessel graft defect","description":"Repair of graft-enteric fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1099.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20664","name":"Appl halo cranial 6+pins","description":"Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":778.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33522","name":"Cabg artery-vein five","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54865","name":"Explore epididymis","description":"Exploration of epididymis, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01940","name":"Anes nulyt agt lmbr/sac","description":"Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; lumbar or sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36573","name":"Insj picc rs&i 5 yr+","description":"Insertion of peripherally inserted central venous catheter (picc), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46060","name":"I&d ischiorectal/ntrmrl absc","description":"Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, with or without placement of seton","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52275","name":"Cystoscopy & revise urethra","description":"Cystourethroscopy, with internal urethrotomy; male","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0843","name":"Pwc gp2 hd mult pow opt s/b","description":"Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64635","name":"Destroy lumb/sac facet jnt","description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); lumbar or sacral, single facet joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0515","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64763","name":"Incise hip/thigh nerve","description":"Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":445.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31298","name":"Nsl/sins ndsc surg frnt&sphn","description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2212","name":"Prolong outpt/office vis","description":"Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or w","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87106","name":"Fungi identification yeast","description":"Culture, fungi, definitive identification, each organism; yeast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67141","name":"Proph rta dtchmnt crtx dthrm","description":"Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; cryotherapy, diathermy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":316.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0302","name":"Ex hd hosp bed > 600 lbs","description":"Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9552","name":"F18 fdg","description":"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93025","name":"Microvolt t-wave assess","description":"Microvolt t-wave alternans for assessment of ventricular arrhythmias","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12035","name":"Intmd rpr s/a/t/ext 12.6-20","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43201","name":"Esoph scope w/submucous inj","description":"Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85651","name":"Rbc sed rate nonautomated","description":"Sedimentation rate, erythrocyte; non-automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43634","name":"Removal of stomach partial","description":"Gastrectomy, partial, distal; with formation of intestinal pouch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99184","name":"Hypothermia ill neonate","description":"Initiation of selective head or total body hypothermia in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude eeg, supervision of controlled hypothermia, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32854","name":"Lung transplant with bypass","description":"Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3934.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33968","name":"Remove aortic assist device","description":"Removal of intra-aortic balloon assist device, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5160","name":"Mold socket bent knee shin s","description":"Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96111","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20931","name":"Sp bone algrft struct add-on","description":"Allograft, structural, for spine surgery only (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2008","name":"Post-d/c h vst ext pt 45 m","description":"Moderate (45 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient fac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46045","name":"I&d absc tranal under anes","description":"Incision and drainage of intramural, intramuscular, or submucosal abscess, transanal, under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26260","name":"Resect prox finger tumor","description":"Radical resection of tumor, proximal or middle phalanx of finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95937","name":"Neuromuscular junction test","description":"Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28305","name":"Incise/graft midfoot bones","description":"Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes obtaining graft) (eg, fowler type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77306","name":"Telethx isodose plan simple","description":"Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80200","name":"Assay of tobramycin","description":"Tobramycin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54100","name":"Biopsy of penis","description":"Biopsy of penis; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33767","name":"Shunt supr v/c p-art bth lng","description":"Shunt; superior vena cava to pulmonary artery for flow to both lungs (bidirectional glenn procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1234.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5714","name":"Knee-shin exo variable frict","description":"Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29085","name":"Appl cast hand&lwr forearm","description":"Application, cast; hand and lower forearm (gauntlet)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35141","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral artery (profunda femoris, superficial femoral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":969.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43121","name":"Partial removal of esophagus","description":"Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without proximal gastrectomy, with thoracic esophagogastrostomy, with or without pyloroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90956","name":"Esrd srv 1 visit p mo 2-11","description":"End-stage renal disease (esrd) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81204","name":"Ar gene charac alleles","description":"Ar (androgen receptor) (eg, spinal and bulbar muscular atrophy, kennedy disease, x chromosome inactivation) gene analysis; characterization of alleles (eg, expanded size or methylation status)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33262","name":"Rmvl& replc pulse gen 1 lead","description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27626","name":"Remove ankle joint lining","description":"Arthrotomy, with synovectomy, ankle; including tenosynovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":497.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57454","name":"Bx/curett of cervix w/scope","description":"Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92502","name":"Ear and throat examination","description":"Otolaryngologic examination under general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95971","name":"Alys smpl sp/pn npgt w/prgrm","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84061","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00145","name":"Anes px eye vitreortnl surg","description":"Anesthesia for procedures on eye; vitreoretinal surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81005","name":"Urinalysis","description":"Urinalysis; qualitative or semiquantitative, except immunoassays","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93289","name":"Interrog device eval heart","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including anal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59160","name":"D & c after delivery","description":"Curettage, postpartum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95929","name":"C motor evoked lwr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2215","name":"Pneumatic caster tire tube","description":"Manual wheelchair accessory, tube for pneumatic caster tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33229","name":"Remv&replc pm gen mult leads","description":"Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0244","name":"Toilet seat raised","description":"Raised toilet seat","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64897","name":"Nrv grf mltst arm/leg <4 cm","description":"Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88150","name":"Cytopath c/v manual","description":"Cytopathology, slides, cervical or vaginal; manual screening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80197","name":"Assay of tacrolimus","description":"Tacrolimus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79300","name":"Nuclr rx interstit colloid","description":"Radiopharmaceutical therapy, by interstitial radioactive colloid administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36569","name":"Insj picc 5 yr+ w/o imaging","description":"Insertion of peripherally inserted central venous catheter (picc), without subcutaneous port or pump, without imaging guidance; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64611","name":"Chemodenerv saliv glands","description":"Chemodenervation of parotid and submandibular salivary glands, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15733","name":"Musc myoq/fscq flp h&n pedcl","description":"Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":657.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78605","name":"Brain image 4+ views","description":"Brain imaging, minimum 4 static views;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46320","name":"Removal of hemorrhoid clot","description":"Excision of thrombosed hemorrhoid, external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5200","name":"Kne sing axis fric shin sach","description":"Above knee, molded socket, single axis constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26725","name":"Treat finger fracture each","description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2114","name":"Afo tib fx semi-rigid","description":"Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21400","name":"Closed tx orbit w/o manipulj","description":"Closed treatment of fracture of orbit, except blowout; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32486","name":"Sleeve lobectomy","description":"Removal of lung, other than pneumonectomy; with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91040","name":"Esoph balloon distension tst","description":"Esophageal balloon distension study, diagnostic, with provocation when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11040","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62305","name":"Myelography lumbar injection","description":"Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27767","name":"Cltx post ankle fx","description":"Closed treatment of posterior malleolus fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":237.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21346","name":"Opn tx nasomax fx w/fixj","description":"Open treatment of nasomaxillary complex fracture (lefort ii type); with wiring and/or local fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94619","name":"Exercise tst brncspsm wo ecg","description":"Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; without electrocardiographic recording(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01953","name":"Anes 2&3 burn ea add 9% tbsa","description":"Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (tbsa) treated during anesthesia and surgery; each additional 9% total body surface area or part thereof (list separately in addition to code for primary procedur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1298","name":"Wheelchair spec seat depth/w","description":"Special wheelchair seat depth and/or width, by construction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2030","name":"Kafo dbl solid stirrup w/o j","description":"Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar ak orthosis), without knee joint, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59525","name":"Remove uterus after cesarean","description":"Subtotal or total hysterectomy after cesarean delivery (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":434.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67880","name":"Revision of eyelid","description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42836","name":"Removal of adenoids","description":"Adenoidectomy, secondary; age 12 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77049","name":"Mri breast c-+ w/cad bi","description":"Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (cad real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4104","name":"Additive for enteral formula","description":"Additive for enteral formula (e.g., fiber)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77790","name":"Radiation handling","description":"Supervision, handling, loading of radiation source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11641","name":"Exc f/e/e/n/l mal+mrg 0.6-1","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21406","name":"Opn tx orbit fx w/o implant","description":"Open treatment of fracture of orbit, except blowout; without implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32673","name":"Thoracoscopy w/thymus resect","description":"Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47543","name":"Endoluminal bx biliary tree","description":"Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":354.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87101","name":"Skin fungi culture","description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90838","name":"Psytx w pt w e/m 60 min","description":"Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99148","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71034","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27087","name":"Remove hip foreign body","description":"Removal of foreign body, pelvis or hip; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2395","name":"Caster wheel excludes tire","description":"Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5988","name":"Vertical shock reducing pylo","description":"Addition to lower limb prosthesis, vertical shock reducing pylon feature","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":973.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37145","name":"Revision of circulation","description":"Venous anastomosis, open; renoportal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1895.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28341","name":"Resect enlarged toe","description":"Reconstruction, toe, macrodactyly; requiring bone resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38550","name":"Removal neck/armpit lesion","description":"Excision of cystic hygroma, axillary or cervical; without deep neurovascular dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0275","name":"Bed pan standard","description":"Bed pan, standard, metal or plastic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55040","name":"Removal of hydrocele","description":"Excision of hydrocele; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92316","name":"C-lens fitg tech aphakia ou","description":"Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, both eyes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92020","name":"Gonioscopy","description":"Gonioscopy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58605","name":"Division of fallopian tube","description":"Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27286","name":"Arthrd hip jt sbtrchc osteot","description":"Arthrodesis, hip joint (including obtaining graft); with subtrochanteric osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25251","name":"Removal of wrist prosthesis","description":"Removal of wrist prosthesis; complicated, including total wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84482","name":"T3 reverse","description":"Triiodothyronine t3; reverse","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00832","name":"Anes hernia repair vnt&incal","description":"Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85635","name":"Reptilase test","description":"Reptilase test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46257","name":"Remove in/ex hem grp & fiss","description":"Hemorrhoidectomy, internal and external, single column/group; with fissurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83935","name":"Assay of urine osmolality","description":"Osmolality; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28530","name":"Treat sesamoid bone fracture","description":"Closed treatment of sesamoid fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29881","name":"Arthrs kne srg mnisectmy m/l","description":"Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72195","name":"Mri pelvis w/o dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94350","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33615","name":"Repair modified fontan","description":"Repair of complex cardiac anomalies (eg, tricuspid atresia) by closure of atrial septal defect and anastomosis of atria or vena cava to pulmonary artery (simple fontan procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86622","name":"Brucella antibody","description":"Antibody; brucella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93657","name":"Tx l/r atrial fib addl","description":"Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75600","name":"Contrast exam thoracic aorta","description":"Aortography, thoracic, without serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93452","name":"Left hrt cath w/ventrclgrphy","description":"Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":915.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53431","name":"Reconstruct urethra/bladder","description":"Urethroplasty with tubularization of posterior urethra and/or lower bladder for incontinence (eg, tenago, leadbetter procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":933.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33011","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4355","name":"Bladder irrigation tubing","description":"Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57410","name":"Pelvic examination","description":"Pelvic examination under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0486","name":"Mon cable elec/pneum vad rep","description":"Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31002","name":"Irrigation sphenoid sinus","description":"Lavage by cannulation; sphenoid sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2520","name":"Contact lens hydrophilic","description":"Contact lens, hydrophilic, spherical, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4726","name":"Dialys sol fld vol > 5999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1028","name":"W/c manual swingaway","description":"Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94729","name":"Diffusing capacity","description":"Diffusing capacity (eg, carbon monoxide, membrane) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95250","name":"Cont gluc mntr phys/qhp eqp","description":"Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and pr","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4541","name":"Large disposable underpad","description":"Incontinence product, disposable underpad, large, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54692","name":"Laparoscopy orchiopexy","description":"Laparoscopy, surgical; orchiopexy for intra-abdominal testis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87190","name":"Sc std myobacteria prop meth","description":"Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40805","name":"Removal foreign body mouth","description":"Removal of embedded foreign body, vestibule of mouth; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24301","name":"Musc/tdn transfer upr a/e 1","description":"Muscle or tendon transfer, any type, upper arm or elbow, single (excluding 24320-24331)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74440","name":"X-ray male genital tract","description":"Vasography, vesiculography, or epididymography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87636","name":"Sarscov2 & inf a&b amp prb","description":"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) and influenza virus types a and b, multiplex amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55821","name":"Removal of prostate","description":"Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); suprapubic, subtotal, 1 or 2 stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":707.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27326","name":"Neurectomy popliteal","description":"Neurectomy, popliteal (gastrocnemius)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6945","name":"Elbow disart myoelectronic c","description":"Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70486","name":"Ct maxillofacial w/o dye","description":"Computed tomography, maxillofacial area; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99401","name":"Prev med cnsl indiv apprx 15","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0748","name":"Elec osteogen stim spinal","description":"Osteogenesis stimulator, electrical, non-invasive, spinal applications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50727","name":"Revise ureter","description":"Revision of urinary-cutaneous anastomosis (any type urostomy);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66175","name":"Trluml dil aq o/f can w/st","description":"Transluminal dilation of aqueous outflow canal (eg, canaloplasty); with retention of device or stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6697","name":"Cus elbo skt in not con/atyp","description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21141","name":"Rcnstj midface lefort i 1pc","description":"Reconstruction midface, lefort i; single piece, segment movement in any direction (eg, for long face syndrome), without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1068.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77316","name":"Brachytx isodose plan simple","description":"Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1887","name":"Catheter, guiding","description":"Catheter, guiding (may include infusion/perfusion capability)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41821","name":"Excision of gum flap","description":"Operculectomy, excision pericoronal tissues","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21121","name":"Geniop sldg osteot 1","description":"Genioplasty; sliding osteotomy, single piece","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65875","name":"Incise inner eye adhesions","description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25320","name":"Repair/revise wrist joint","description":"Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":821.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0513","name":"Prolong prev svcs, first 30m","description":"Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6205","name":"Elbow molded w/ expand inter","description":"Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2031.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65900","name":"Remove eye lesion","description":"Removal of epithelial downgrowth, anterior chamber of eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63277","name":"Bx/exc xdrl spine lesn lmbr","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86666","name":"Ehrlichia antibody","description":"Antibody; ehrlichia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45500","name":"Repair of rectum","description":"Proctoplasty; for stenosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37790","name":"Penile venous occlusion","description":"Penile venous occlusive procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42507","name":"Parotid duct diversion","description":"Parotid duct diversion, bilateral (wilke type procedure);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23530","name":"Optx strnclav dislc aqt/chrn","description":"Open treatment of sternoclavicular dislocation, acute or chronic;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33620","name":"Apply r&l pulm art bands","description":"Application of right and left pulmonary artery bands (eg, hybrid approach stage 1)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1435.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83775","name":"Assay malate dehydrogenase","description":"Malate dehydrogenase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87653","name":"Strep b dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); streptococcus, group b, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45333","name":"Sigmoidoscopy & polypectomy","description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82565","name":"Assay of creatinine","description":"Creatinine; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77073","name":"Bone length studies","description":"Bone length studies (orthoroentgenogram, scanogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54240","name":"Penile plethysmography","description":"Penile plethysmography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86156","name":"Cold agglutinin screen","description":"Cold agglutinin; screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78832","name":"Rp loclzj tum spect w/ct 2","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect) with concurrently acquired computed tomography (ct) transmission scan for anatomical review, localizati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4189","name":"Parenteral sol amino acid &","description":"Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57308","name":"Fistula repair transperine","description":"Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58770","name":"Create new tubal opening","description":"Salpingostomy (salpingoneostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":552.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43460","name":"Pressure treatment esophagus","description":"Esophagogastric tamponade, with balloon (sengstaken type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34451","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by abdominal and leg incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5981","name":"Flex-walk sys low ext prosth","description":"All lower extremity prostheses, flex-walk system or equal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1539.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43882","name":"Rev/rmvl gstr nstim eltrd","description":"Revision or removal of gastric neurostimulator electrodes, antrum, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61535","name":"Remove brain electrodes","description":"Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":905.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25390","name":"Shorten radius or ulna","description":"Osteoplasty, radius or ulna; shortening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33803","name":"Div aberrant vsl w/reanast","description":"Division of aberrant vessel (vascular ring); with reanastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":999.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2222","name":"Solid caster integ whl, repl","description":"Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24579","name":"Optx humrl cndylr fracture","description":"Open treatment of humeral condylar fracture, medial or lateral, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":699.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87341","name":"Hep b surface ag neutrlzj ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hepatitis b surface antigen (hbsag) neutralization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30465","name":"Repair nasal stenosis","description":"Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2360","name":"22nf nonsealed leadacid","description":"Power wheelchair accessory, 22nf non-sealed lead acid battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84450","name":"Transferase (ast) (sgot)","description":"Transferase; aspartate amino (ast) (sgot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45350","name":"Sgmdsc w/band ligation","description":"Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49491","name":"Rpr hern preemie reduc","description":"Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":665.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60200","name":"Remove thyroid lesion","description":"Excision of cyst or adenoma of thyroid, or transection of isthmus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":559.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5600","name":"Hip disart sach laminat mold","description":"Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3740","name":"Cuffs adj lock w/ active con","description":"Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5701","name":"Replace socket above knee","description":"Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1717.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78451","name":"Ht muscle image spect sing","description":"Myocardial perfusion imaging, tomographic (spect) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":271.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78830","name":"Rp loclzj tum spect w/ct 1","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect) with concurrently acquired computed tomography (ct) transmission scan for anatomical review, localizati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92136","name":"Ophthalmic biometry","description":"Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6442","name":"Conform band n/s w<3in/yd","description":"Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49618","name":"Rpr aa hrn rcr > 10 ncr/strn","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, incarcerated or strangulate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":990.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28435","name":"Cltx talus fracture w/mnpj","description":"Closed treatment of talus fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74470","name":"X-ray exam of kidney lesion","description":"Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21743","name":"Repair sternum/nuss w/scope","description":"Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (nuss procedure), with thoracoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93668","name":"Peripheral vascular rehab","description":"Peripheral arterial disease (pad) rehabilitation, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9157","name":"Transesoph doppl cardiac mon","description":"Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57720","name":"Revision of cervix","description":"Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97810","name":"Acup 1/> wo estim 1st 15 min","description":"Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70488","name":"Ct maxillofacial w/o & w/dye","description":"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64585","name":"Rev/rmv perph nstim eltrd ra","description":"Revision or removal of peripheral neurostimulator electrode array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71021","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1390","name":"Oxygen concentrator","description":"Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28260","name":"Release of midfoot joint","description":"Capsulotomy, midfoot; medial release only (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":571.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11750","name":"Excision nail&nail matrix","description":"Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15002","name":"Wound prep trk/arm/leg","description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97163","name":"Pt eval high complex 45 min","description":"Physical therapy evaluation: high complexity, requiring these components: a history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; an examination of body systems using standardized tests and measures addressing a total of 4 or more elements from","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27535","name":"Treat knee fracture","description":"Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50860","name":"Transplant ureter to skin","description":"Ureterostomy, transplantation of ureter to skin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83068","name":"Hemoglobin unstable screen","description":"Hemoglobin; unstable, screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49402","name":"Remove foreign body adbomen","description":"Removal of peritoneal foreign body from peritoneal cavity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78278","name":"Acute gi blood loss imaging","description":"Acute gastrointestinal blood loss imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97532","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20551","name":"Njx 1 tendon origin/insj","description":"Injection(s); single tendon origin/insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0047","name":"Elev legrst upr hangr rep ea","description":"Elevating legrest, upper hanger bracket, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11623","name":"Exc s/n/h/f/g mal+mrg 2.1-3","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73525","name":"Contrast x-ray of hip","description":"Radiologic examination, hip, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82777","name":"Galectin-3","description":"Galectin-3","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26160","name":"Remove tendon sheath lesion","description":"Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":468.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82140","name":"Assay of ammonia","description":"Ammonia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25118","name":"Excise wrist tendon sheath","description":"Synovectomy, extensor tendon sheath, wrist, single compartment;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6024","name":"Collagen dsg wound filler","description":"Collagen dressing wound filler, sterile, per 6 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20816","name":"Replantation digit complete","description":"Replantation, digit, excluding thumb (includes metacarpophalangeal joint to insertion of flexor sublimis tendon), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96423","name":"Chemo ia infuse each addl hr","description":"Chemotherapy administration, intra-arterial; infusion technique, each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1970","name":"Afo plastic molded w/ankle j","description":"Ankle foot orthosis, plastic with ankle joint, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32552","name":"Remove lung catheter","description":"Removal of indwelling tunneled pleural catheter with cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0990","name":"Wheelchair elevating leg res","description":"Wheelchair accessory, elevating leg rest, complete assembly, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84307","name":"Assay of somatostatin","description":"Somatostatin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88172","name":"Cytp dx eval fna 1st ea site","description":"Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5081","name":"Stoma plug or seal, any type","description":"Stoma plug or seal, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19324","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":343.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25445","name":"Arthrp w/prostc trapezium","description":"Arthroplasty with prosthetic replacement; trapezium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42825","name":"Removal of tonsils","description":"Tonsillectomy, primary or secondary; younger than age 12","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2003","name":"Post-d/c h vst new pt 45 m","description":"Moderate (45 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01420","name":"Anes cst appl rmv/rpr kne jt","description":"Anesthesia for all cast applications, removal, or repair involving knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7031","name":"Replacement facemask interfa","description":"Face mask interface, replacement for full face mask, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96158","name":"Hlth bhv ivntj indiv 1st 30","description":"Health behavior intervention, individual, face-to-face; initial 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2126","name":"Kafo fem fx cast thermoplas","description":"Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3973","name":"Sewho airplane w/jnt(s) cf","description":"Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":877.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0912","name":"Hd trapeze bar free standing","description":"Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83090","name":"Assay of homocysteine","description":"Homocysteine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79005","name":"Nuclear rx oral admin","description":"Radiopharmaceutical therapy, by oral administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87807","name":"Rsv assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97814","name":"Acup 1/> w/estim ea addl 15","description":"Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with insertion of needle(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00124","name":"Anes px ear otoscopy","description":"Anesthesia for procedures on external, middle, and inner ear including biopsy; otoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27824","name":"Treat lower leg fracture","description":"Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63001","name":"Remove spine lamina 1/2 crvl","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82300","name":"Assay of cadmium","description":"Cadmium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65270","name":"Repair of eye wound","description":"Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86829","name":"Hla class i/ii antibody qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to hla class i or class ii hla antigens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28400","name":"Cltx calcaneal fx w/o mnpj","description":"Closed treatment of calcaneal fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61537","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, without electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86727","name":"Lymph choriomeningitis ab","description":"Antibody; lymphocytic choriomeningitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35111","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, splenic artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64455","name":"Njx aa&/strd pltr com dg nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, mortons neuroma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93656","name":"Compre ep eval abltj atr fib","description":"Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, and intracardiac catheter ablation of atrial fibrillation by ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66220","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":445.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31643","name":"Diag bronchoscope/catheter","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of catheter(s) for intracavitary radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5982","name":"Exoskeletal axial rotation u","description":"All exoskeletal lower extremity prostheses, axial rotation unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28286","name":"Repair of hammertoe","description":"Correction, cock-up fifth toe, with plastic skin closure (eg, ruiz-mora type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62320","name":"Njx interlaminar crv/thrc","description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90791","name":"Psych diagnostic evaluation","description":"Psychiatric diagnostic evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45379","name":"Colonoscopy w/fb removal","description":"Colonoscopy, flexible; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":327.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75731","name":"Artery x-rays adrenal gland","description":"Angiography, adrenal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59051","name":"Fetal monitor/interpret only","description":"Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; interpretation only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92981","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":214.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2430","name":"Lens variable asphericity bi","description":"Variable asphericity lens, bifocal, full field, glass or plastic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22319","name":"Treat odontoid fx w/graft","description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76775","name":"Us exam abdo back wall lim","description":"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01740","name":"Anes opn/arthrs px elbw nos","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78730","name":"Urinary bladder retention","description":"Urinary bladder residual study (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28190","name":"Removal of foot foreign body","description":"Removal of foreign body, foot; subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92953","name":"Temporary external pacing","description":"Temporary transcutaneous pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60225","name":"Partial removal of thyroid","description":"Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":782.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77750","name":"Infuse radioactive materials","description":"Infusion or instillation of radioelement solution (includes 3-month follow-up care)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82950","name":"Glucose test","description":"Glucose; post glucose dose (includes glucose)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15574","name":"Pedcle fh/ch/ch/m/n/ax/g/h/f","description":"Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19082","name":"Bx breast add lesion strtctc","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":304.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86941","name":"Hemolysins/agglutinins","description":"Hemolysins and agglutinins; incubated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0027","name":"Semen analysis","description":"Semen analysis; presence and/or motility of sperm excluding huhner","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96571","name":"Photodynamic tx addl 15 min","description":"Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (list separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72129","name":"Ct chest spine w/dye","description":"Computed tomography, thoracic spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24920","name":"Amputation of upper arm","description":"Amputation, arm through humerus; open, circular (guillotine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81185","name":"Cacna1a gene full gene seq","description":"Cacna1a (calcium voltage-gated channel subunit alpha1 a) (eg, spinocerebellar ataxia) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":423.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69990","name":"Microsurgery add-on","description":"Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19342","name":"Insj/rplcmt brst implt sep d","description":"Insertion or replacement of breast implant on separate day from mastectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76882","name":"Us lmtd jt/fcl evl nvasc xtr","description":"Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01250","name":"Anes all px nrv musc upr leg","description":"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73522","name":"X-ray exam hips bi 3-4 views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26562","name":"Repair of web finger","description":"Repair of syndactyly (web finger) each web space; complex (eg, involving bone, nails)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1133.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1280","name":"Whchr h-duty det arm leg res","description":"Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75625","name":"Contrast exam abdominl aorta","description":"Aortography, abdominal, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2599","name":"Sgd accessory noc","description":"Accessory for speech generating device, not otherwise classified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27715","name":"Ostpl tibfib lngth/shrt","description":"Osteoplasty, tibia and fibula, lengthening or shortening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74019","name":"Radex abdomen 2 views","description":"Radiologic examination, abdomen; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80176","name":"Assay of lidocaine","description":"Lidocaine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58540","name":"Revision of uterus","description":"Hysteroplasty, repair of uterine anomaly (strassman type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27250","name":"Treat hip dislocation","description":"Closed treatment of hip dislocation, traumatic; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94014","name":"Patient recorded spirometry","description":"Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27324","name":"Biopsy thigh soft tissues","description":"Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":343.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51797","name":"Intraabdominal pressure test","description":"Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26536","name":"Revise/implant finger joint","description":"Arthroplasty, interphalangeal joint; with prosthetic implant, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99144","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0110","name":"Crutch forearm pair","description":"Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25075","name":"Exc forearm les sc < 3 cm","description":"Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":420.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70120","name":"X-ray exam of mastoids","description":"Radiologic examination, mastoids; less than 3 views per side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70546","name":"Mr angiograph head w/o&w/dye","description":"Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":295.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7002","name":"Tubing used w suction pump","description":"Tubing, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62258","name":"Replace brain cavity shunt","description":"Removal of complete cerebrospinal fluid shunt system; with replacement by similar or other shunt at same operation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56633","name":"Vulvectomy radical complete","description":"Vulvectomy, radical, complete;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":773.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38380","name":"Thoracic duct procedure","description":"Suture and/or ligation of thoracic duct; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75902","name":"Remove cva lumen obstruct","description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6905","name":"Hand restoration multiple fi","description":"Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6512","name":"Compres burn garment, noc","description":"Compression burn garment, not otherwise classified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93356","name":"Myocrd strain img spckl trck","description":"Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (list separately in addition to codes for echocardiography imaging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78454","name":"Ht musc image planar mult","description":"Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33425","name":"Repair of mitral valve","description":"Valvuloplasty, mitral valve, with cardiopulmonary bypass;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2378.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63662","name":"Remove spine eltrd plate","description":"Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":747.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82150","name":"Assay of amylase","description":"Amylase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40650","name":"Rpr lip fth vermilion only","description":"Repair lip, full thickness; vermilion only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70130","name":"X-ray exam of mastoids","description":"Radiologic examination, mastoids; complete, minimum of 3 views per side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23600","name":"Cltx prox humrl fx w/o mnpj","description":"Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85301","name":"Antithrombin iii antigen","description":"Clotting inhibitors or anticoagulants; antithrombin iii, antigen assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26498","name":"Finger tendon transfer","description":"Transfer of tendon to restore intrinsic function; all 4 fingers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5656","name":"Socket insert knee articulat","description":"Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":241.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32555","name":"Aspirate pleura w/ imaging","description":"Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8683","name":"Radiofq trsmtr for implt neu","description":"Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90957","name":"Esrd srv 4 vsts p mo 12-19","description":"End-stage renal disease (esrd) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38564","name":"Removal abdomen lymph nodes","description":"Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":463.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50230","name":"Removal kidney open radical","description":"Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1043.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1820","name":"Soft interface material","description":"Replacement soft interface material, dynamic adjustable extension/flexion device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22206","name":"Incis spine 3 column thorac","description":"Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86765","name":"Rubeola antibody","description":"Antibody; rubeola","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4328","name":"Fem urinary collect pouch","description":"Female external urinary collection device; pouch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35271","name":"Rpr blvs gr ot/th vn ntrth w","description":"Repair blood vessel with graft other than vein; intrathoracic, with bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1196.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35201","name":"Repair blood vessel dir neck","description":"Repair blood vessel, direct; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86720","name":"Leptospira antibody","description":"Antibody; leptospira","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67961","name":"Revision of eyelid","description":"Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51555","name":"Partial removal of bladder","description":"Cystectomy, partial; complicated (eg, postradiation, previous surgery, difficult location)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1031.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21436","name":"Optx crnfcl sep comp mlt int","description":"Open treatment of craniofacial separation (lefort iii type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29874","name":"Arthrs knee surg rmv loos/fb","description":"Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33514","name":"Cabg vein five","description":"Coronary artery bypass, vein only; 5 coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2274.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0516T","name":"Insj wcs lv eltrd only","description":"Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; electrode only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96152","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43842","name":"Gstr rstcv px v-banded gstp","description":"Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0693","name":"Uvl sys panel 6 ft","description":"Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24935","name":"Revision of amputation","description":"Stump elongation, upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88182","name":"Cell marker study","description":"Flow cytometry, cell cycle or dna analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78232","name":"Salivary gland function std","description":"Salivary gland function study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88164","name":"Cytopath tbs c/v manual","description":"Cytopathology, slides, cervical or vaginal (the bethesda system); manual screening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21480","name":"Cltx tmprmand dislc 1st/sbsq","description":"Closed treatment of temporomandibular dislocation; initial or subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21235","name":"Ear cartilage graft","description":"Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74020","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29126","name":"Appl short arm splint dyn","description":"Application of short arm splint (forearm to hand); dynamic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50240","name":"Nephrectomy partial","description":"Nephrectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1074.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38525","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, deep axillary node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6910","name":"Hand restoration no fingers","description":"Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":905.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66762","name":"Revision of iris","description":"Iridoplasty by photocoagulation (1 or more sessions) (eg, for improvement of vision, for widening of anterior chamber angle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27665","name":"Repair of leg tendon each","description":"Repair, extensor tendon, leg; secondary, with or without graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93286","name":"Peri-px eval pm/ldls pm ip","description":"Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4375","name":"Drainable plastic pch w fcpl","description":"Ostomy pouch, drainable, with faceplate attached, plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43130","name":"Removal of esophagus pouch","description":"Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66740","name":"Destruction ciliary body","description":"Ciliary body destruction; cyclodialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61711","name":"Fusion of skull arteries","description":"Anastomosis, arterial, extracranial-intracranial (eg, middle cerebral/cortical) arteries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2300","name":"Abduction bar jointed adjust","description":"Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0396","name":"Alcohol/subs interv 15-30mn","description":"Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17264","name":"Dstrj mal les t/a/l 3.1-4.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78804","name":"Rp loclzj tum whbdy 2+d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, requiring 2 or more days imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":537.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68750","name":"Create tear duct drain","description":"Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77316","name":"Brachytx isodose plan simple","description":"Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70496","name":"Ct angiography head","description":"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81312","name":"Pabpn1 gene detc abnor allel","description":"Pabpn1 (poly[a] binding protein nuclear 1) (eg, oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45550","name":"Repair rectum/remove sigmoid","description":"Proctopexy (eg, for prolapse); with sigmoid resection, abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1175.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80200","name":"Assay of tobramycin","description":"Tobramycin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44156","name":"Removal of colon/ileostomy","description":"Colectomy, total, abdominal, with proctectomy; with continent ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85045","name":"Automated reticulocyte count","description":"Blood count; reticulocyte, automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"R0070","name":"Transport portable x-ray","description":"Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69910","name":"Remove inner ear & mastoid","description":"Labyrinthectomy; with mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":809.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84315","name":"Body fluid specific gravity","description":"Specific gravity (except urine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43273","name":"Endoscopic pancreatoscopy","description":"Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (list separately in addition to code(s) for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0837","name":"Pwc gp 2 hd sing pow opt s/b","description":"Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15040","name":"Harvest cultured skin graft","description":"Harvest of skin for tissue cultured skin autograft, 100 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29850","name":"Knee arthroscopy/surgery","description":"Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20983","name":"Ablate bone tumor(s) perq","description":"Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4621.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82638","name":"Assay of dibucaine number","description":"Dibucaine number","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4575","name":"Hyperbaric o2 chamber disps","description":"Topical hyperbaric oxygen chamber, disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0945","name":"Belt/harness extremity","description":"Extremity belt/harness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37187","name":"Venous mech thrombectomy","description":"Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":965.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8310","name":"Truss double w/ standard pad","description":"Truss, double with standard pads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73050","name":"X-ray exam of shoulders","description":"Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74450","name":"X-ray urethra/bladder","description":"Urethrocystography, retrograde, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33390","name":"Valvuloplasty aortic valve","description":"Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (ie, valvotomy, debridement, debulking, and/or simple commissural resuspension)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1678.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71046","name":"X-ray exam chest 2 views","description":"Radiologic examination, chest; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33880","name":"Evasc rpr ta ndgft cov lsa","description":"Endovascular repair of thoracic aorta, including pre-procedure sizing and device selection, nonselective catheterization(s), all associated radiological supervision and interpretation; by deployment of an aorto-aortic tube endograft covering the left subclavian artery and all aortic tube endograft e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86768","name":"Salmonella antibody","description":"Antibody; salmonella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77600","name":"Hyperthermia ext gen supfc","description":"Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":372.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4550","name":"Surgical trays","description":"Surgical trays","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3806","name":"Whfo w/joint(s) custom fab","description":"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":363.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0470","name":"Tlso rigid frame pre subclav","description":"Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restr","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17315","name":"Mohs surg addl block","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86386","name":"Nuclear matrix protein 22","description":"Nuclear matrix protein 22 (nmp22), qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0507","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19112","name":"Excise breast duct fistula","description":"Excision of lactiferous duct fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55705","name":"Bx prst8 any approach nonimg","description":"Biopsy, prostate, any approach, nonimaging-guided","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8435","name":"Pros sock multi ply upper lm","description":"Prosthetic sock, multiple ply, upper limb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26650","name":"Treat thumb fracture","description":"Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (bennett fracture), with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":398.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49587","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":395.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41009","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; masticator space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":316.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86664","name":"Epstein-barr nuclear antigen","description":"Antibody; epstein-barr (eb) virus, nuclear antigen (ebna)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6205","name":"Composite drsg > 48 sq in","description":"Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27267","name":"Cltx thigh fx","description":"Closed treatment of femoral fracture, proximal end, head; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82485","name":"Assay chondroitin sulfate","description":"Chondroitin b sulfate, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83013","name":"H pylori (c-13) breath","description":"Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, c-13)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5061","name":"Pouch drainable w barrier at","description":"Ostomy pouch, drainable; with barrier attached, (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92287","name":"Ant sgm img ir flrscn angrph","description":"Anterior segment imaging with interpretation and report; with fluorescein angiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25443","name":"Arthrp prostc dstl scph crpl","description":"Arthroplasty with prosthetic replacement; scaphoid carpal (navicular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6400","name":"Below elbow prosth tiss shap","description":"Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99607","name":"Mtms by pharm addl 15 min","description":"Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64634","name":"Destroy c/th facet jnt addl","description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); cervical or thoracic, each additional facet joint (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73130","name":"X-ray exam of hand","description":"Radiologic examination, hand; minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93750","name":"Interrogation vad in person","description":"Interrogation of ventricular assist device (vad), in person, with physician or other qualified health care professional analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum status, recovery), with programming, if performe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25394","name":"Repair carpal bone shorten","description":"Osteoplasty, carpal bone, shortening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75880","name":"Vein x-ray eye socket","description":"Venography, orbital, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84466","name":"Assay of transferrin","description":"Transferrin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71111","name":"X-ray exam ribs/chest4/> vws","description":"Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76080","name":"X-ray exam of fistula","description":"Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30580","name":"Repair upper jaw fistula","description":"Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97598","name":"Dbrdmt opn wnd addl 20cm/<","description":"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when perform","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63045","name":"Lam facetec & foramot crv","description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1153.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23031","name":"I&d shoulder infected bursa","description":"Incision and drainage, shoulder area; infected bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81181","name":"Atxn7 gene detc abnor allele","description":"Atxn7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26432","name":"Repair finger tendon","description":"Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet finger)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":423.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87620","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11443","name":"Exc face-mm b9+marg 2.1-3 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33800","name":"Aortic suspension","description":"Aortic suspension (aortopexy) for tracheal decompression (eg, for tracheomalacia) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52325","name":"Cystoscopy stone removal","description":"Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92240","name":"Icg angiography i&r uni/bi","description":"Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41827","name":"Excision of gum lesion","description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56820","name":"Colposcopy vulva","description":"Colposcopy of the vulva;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85306","name":"Clot inhibit prot s free","description":"Clotting inhibitors or anticoagulants; protein s, free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95921","name":"Autonomic nrv parasym inervj","description":"Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded r-r interval, valsalva ratio, and 30:15 ratio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11623","name":"Exc s/n/h/f/g mal+mrg 2.1-3","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26590","name":"Repair finger deformity","description":"Repair macrodactylia, each digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1192.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17263","name":"Dstrj mal les t/a/l 2.1-3.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86039","name":"Antinuclear antibodies (ana)","description":"Antinuclear antibodies (ana); titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63035","name":"Lamot dcmprn nrv rt ea addl","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75733","name":"Artery x-rays adrenals","description":"Angiography, adrenal, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87902","name":"Nfct agt gntyp alys hep c","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); hepatitis c virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26750","name":"Treat finger fracture each","description":"Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5616","name":"Ak univ multiplex sys frict","description":"Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00567","name":"Anes direct cabg w/pump","description":"Anesthesia for direct coronary artery bypass grafting; with pump oxygenator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99368","name":"Team conf w/o pat by hc pro","description":"Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32674","name":"Thoracoscopy lymph node exc","description":"Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2090","name":"Hkafo unilat torsion ball br","description":"Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84703","name":"Chorionic gonadotropin assay","description":"Gonadotropin, chorionic (hcg); qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11012","name":"Deb skin bone at fx site","description":"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25622","name":"Cltx carpl scphd fx w/o mnpj","description":"Closed treatment of carpal scaphoid (navicular) fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86325","name":"Other immunoelectrophoresis","description":"Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4161","name":"Ef ped hydrolyzed/amino acid","description":"Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21256","name":"Reconstruction of orbit","description":"Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86329","name":"Immunodiffusion nes","description":"Immunodiffusion; not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0170","name":"Commode chair electric","description":"Commode chair with integrated seat lift mechanism, electric, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31225","name":"Removal of upper jaw","description":"Maxillectomy; without orbital exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96931","name":"Rcm img acquisj&i&r 1st les","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48556","name":"Removal allograft pancreas","description":"Removal of transplanted pancreatic allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1062.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76498","name":"Unlisted mr procedure","description":"Unlisted magnetic resonance procedure (eg, diagnostic, interventional)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69110","name":"Remove external ear partial","description":"Excision external ear; partial, simple repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":375.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86906","name":"Bld typing serologic rh phnt","description":"Blood typing, serologic; rh phenotyping, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62319","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19368","name":"Brst rcnstj 1pdcl tram anast","description":"Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (tram) flap, requiring separate microvascular anastomosis (supercharging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35666","name":"Bpg fem-ant tib pst tib/prnl","description":"Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or peroneal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1119.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51102","name":"Drain bl w/cath insertion","description":"Aspiration of bladder; with insertion of suprapubic catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76100","name":"X-ray exam of body section","description":"Radiologic examination, single plane body section (eg, tomography), other than with urography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92572","name":"Staggered spondaic word test","description":"Staggered spondaic word test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0439T","name":"Myocrd contrast prfuj echo","description":"Myocardial contrast perfusion echocardiography, at rest or with stress, for assessment of myocardial ischemia or viability (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93294","name":"Rem interrog evl pm/ldls pm","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92616","name":"Fees w/laryngeal sense test","description":"Flexible endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99489","name":"Cplx chrnc care ea addl 30","description":"Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87810","name":"Chlmyd trach assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; chlamydia trachomatis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66160","name":"Glaucoma surgery","description":"Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8460","name":"Camisole post-mast","description":"Camisole, post-mastectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58410","name":"Suspension of uterus","description":"Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; with presacral sympathectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61518","name":"Removal of brain lesion","description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3255","name":"Orth foot non-standard size/","description":"Non-standard size or length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0870","name":"Pwc gp 4 hd seat/back","description":"Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21920","name":"Biopsy soft tissue of back","description":"Biopsy, soft tissue of back or flank; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92517","name":"Vemp test i&r cervical","description":"Vestibular evoked myogenic potential (vemp) testing, with interpretation and report; cervical (cvemp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59850","name":"Induced abortion 1+ njx","description":"Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":342.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31256","name":"Exploration maxillary sinus","description":"Nasal/sinus endoscopy, surgical, with maxillary antrostomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93294","name":"Rem interrog evl pm/ldls pm","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74425","name":"Urography antegrade rs&i","description":"Urography, antegrade, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2212","name":"Lens sphcyl bifo 7.25-12/2.2","description":"Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27075","name":"Resect hip tumor","description":"Radical resection of tumor; wing of ilium, 1 pubic or ischial ramus or symphysis pubis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1778.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57308","name":"Fistula repair transperine","description":"Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0974","name":"W/ch access anti-rollback","description":"Manual wheelchair accessory, anti-rollback device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68110","name":"Exc les conjunctiva <1 cm","description":"Excision of lesion, conjunctiva; up to 1 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62325","name":"Njx interlaminar crv/thrc","description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thorac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27832","name":"Treat lower leg dislocation","description":"Open treatment of proximal tibiofibular joint dislocation, includes internal fixation, when performed, or with excision of proximal fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":637.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63287","name":"Bx/exc idrl imed lesn thrlmb","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5637","name":"Below knee total contact","description":"Addition to lower extremity, below knee, total contact","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76391","name":"Mr elastography","description":"Magnetic resonance (eg, vibration) elastography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62148","name":"Retr bone flap to fix skull","description":"Incision and retrieval of subcutaneous cranial bone graft for cranioplasty (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21936","name":"Resect back tum 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35005","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, vertebral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92618","name":"Ex for nonspeech dev rx add","description":"Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33983","name":"Replace vad intra w/bp","description":"Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34848","name":"Visc & infraren abd 4+ prost","description":"Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2396.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64505","name":"N block spenopalatine gangl","description":"Injection, anesthetic agent; sphenopalatine ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57454","name":"Bx/curett of cervix w/scope","description":"Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69020","name":"Drg xtrnl aud canal abscess","description":"Drainage external auditory canal, abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29105","name":"Application long arm splint","description":"Application of long arm splint (shoulder to hand)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25315","name":"Revise palsy hand tendon(s)","description":"Flexor origin slide (eg, for cerebral palsy, volkmann contracture), forearm and/or wrist;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92937","name":"Prq trluml revsc cab grf 1","description":"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed, single major coronary artery and/or its branches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6645","name":"Shoulder flexion-abduction j","description":"Upper extremity addition, shoulder flexion-abduction joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27412","name":"Autochondrocyte implant knee","description":"Autologous chondrocyte implantation, knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50389","name":"Remove renal tube w/fluoro","description":"Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22310","name":"Closed tx vert fx w/o manj","description":"Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46917","name":"Laser surgery anal lesions","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4035","name":"Enteral feed supp pump per d","description":"Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22849","name":"Reinsert spinal fixation","description":"Reinsertion of spinal fixation device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26025","name":"Drainage of palm bursa","description":"Drainage of palmar bursa; single, bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62323","name":"Njx interlaminar lmbr/sac","description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluorosc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33015","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":422.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3170","name":"Foot plas heel stabi pre ots","description":"Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5535","name":"Prep bk ptb open end socket","description":"Preparatory, below knee ptb type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":941.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27610","name":"Explore/treat ankle joint","description":"Arthrotomy, ankle, including exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":541.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15776","name":"Hair trnspl >15 punch grafts","description":"Punch graft for hair transplant; more than 15 punch grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19301","name":"Partial mastectomy","description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21086","name":"Impres&prep auricular prosth","description":"Impression and custom preparation; auricular prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1318.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92355","name":"Fitg spect lw vis cmpnd lens","description":"Fitting of spectacle mounted low vision aid; telescopic or other compound lens system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0434","name":"Portable liquid 02","description":"Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29720","name":"Repair spica body cst/jacket","description":"Repair of spica, body cast or jacket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93461","name":"R&l hrt art/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, cath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70250","name":"X-ray exam of skull","description":"Radiologic examination, skull; less than 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28406","name":"Prq skel fix clcnl fx w/mnpj","description":"Percutaneous skeletal fixation of calcaneal fracture, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86744","name":"Nocardia antibody","description":"Antibody; nocardia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42844","name":"Extensive surgery of throat","description":"Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with local flap (eg, tongue, buccal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1076.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11441","name":"Exc face-mm b9+marg 0.6-1 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11000","name":"Dbrdmt ecz/infected skin<10%","description":"Debridement of extensive eczematous or infected skin; up to 10% of body surface","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92201","name":"Opscpy extnd rta draw uni/bi","description":"Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S0199","name":"Med abortion inc all ex drug","description":"Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6223","name":"Gauze >16<=48 no w/sal w/o b","description":"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61552","name":"Release of skull seams","description":"Craniectomy for craniosynostosis; multiple cranial sutures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31612","name":"Perq trchl pnxr ttrach aspir","description":"Tracheal puncture, percutaneous with transtracheal aspiration and/or injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3651","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27347","name":"Remove knee cyst","description":"Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43030","name":"Cricopharyngeal myotomy","description":"Cricopharyngeal myotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59612","name":"Vbac delivery only","description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68340","name":"Separate eyelid adhesions","description":"Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":352.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38382","name":"Thoracic duct procedure","description":"Suture and/or ligation of thoracic duct; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6610","name":"Flexible metal hinge pair","description":"Upper extremity additions, flexible metal hinge, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44800","name":"Excision of bowel pouch","description":"Excision of meckels diverticulum (diverticulectomy) or omphalomesenteric duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":635.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76937","name":"Us guide vascular access","description":"Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (list separately in addition to code for primary ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25040","name":"Arthrt rdcrpl/midcarpl jt","description":"Arthrotomy, radiocarpal or midcarpal joint, with exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":469.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27784","name":"Treatment of fibula fracture","description":"Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84202","name":"Assay rbc protoporphyrin","description":"Protoporphyrin, rbc; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88358","name":"Analysis tumor","description":"Morphometric analysis; tumor (eg, dna ploidy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33030","name":"Partial removal of heart sac","description":"Pericardiectomy, subtotal or complete; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1736.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84181","name":"Western blot test","description":"Protein; western blot, with interpretation and report, blood or other body fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95134","name":"Immntx 5 sting insects","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 5 stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00218","name":"Anes icr px in sitting pos","description":"Anesthesia for intracranial procedures; procedures in sitting position","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29010","name":"Appl risser jacket body only","description":"Application of risser jacket, localizer, body; only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77310","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0037","name":"Hi mount flip-up footrest ea","description":"High mount flip-up footrest, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23105","name":"Arthrotomy glenohumeral jt","description":"Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86781","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2613","name":"Position back cush wd <22in","description":"Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87556","name":"M.tuberculo dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria tuberculosis, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93618","name":"Indctj arrhythmia elec pacg","description":"Induction of arrhythmia by electrical pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65920","name":"Remove implant of eye","description":"Removal of implanted material, anterior segment of eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93888","name":"Intracranial limited study","description":"Transcranial doppler study of the intracranial arteries; limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55200","name":"Incision of sperm duct","description":"Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0371","name":"Nonpower mattress overlay","description":"Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64510","name":"N block stellate ganglion","description":"Injection, anesthetic agent; stellate ganglion (cervical sympathetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2999","name":"Lower extremity orthosis nos","description":"Lower extremity orthoses, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65273","name":"Repair of eye wound","description":"Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53265","name":"Treatment of urethra lesion","description":"Excision or fulguration; urethral caruncle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28585","name":"Repair foot dislocation","description":"Open treatment of talotarsal joint dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28825","name":"Partial amputation of toe","description":"Amputation, toe; interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":435.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31030","name":"Exploration maxillary sinus","description":"Sinusotomy, maxillary (antrotomy); radical (caldwell-luc) without removal of antrochoanal polyps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10036","name":"Plmt sft tiss loclzj dev ea","description":"Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82482","name":"Assay rbc cholinesterase","description":"Cholinesterase; rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16000","name":"Initial treatment of burn(s)","description":"Initial treatment, first degree burn, when no more than local treatment is required","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93644","name":"Ep eval subq impl dfb","description":"Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20930","name":"Sp bone algrft morsel add-on","description":"Allograft, morselized, or placement of osteopromotive material, for spine surgery only (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20206","name":"Biopsy muscle perq needle","description":"Biopsy, muscle, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":191.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50541","name":"Laparo ablate renal cyst","description":"Laparoscopy, surgical; ablation of renal cysts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98970","name":"Nqhp ol dig assmt&mgmt 5-10","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20704","name":"Mnl prep&insj i-artic rx dev","description":"Manual preparation and insertion of drug-delivery device(s), intra-articular (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46606","name":"Anoscopy and biopsy","description":"Anoscopy; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9505","name":"Tl201 thallium","description":"Thallium tl-201 thallous chloride, diagnostic, per millicurie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0398","name":"Home sleep test/type 2 porta","description":"Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6590","name":"Shdr fair lead cable direct","description":"Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64778","name":"Digit nerve surgery add-on","description":"Excision of neuroma; digital nerve, each additional digit (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8695","name":"External recharg sys extern","description":"External recharging system for battery (external) for use with implantable neurostimulator, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0275","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22524","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5831.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6682","name":"Test sock elbw disart/above","description":"Upper extremity addition, test socket, elbow disarticulation or above elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61304","name":"Crnec/crnot expl supratntorl","description":"Craniectomy or craniotomy, exploratory; supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5650","name":"Tot contact ak/knee disart s","description":"Additions to lower extremity, total contact, above knee or knee disarticulation socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0603","name":"Repl batt alkaline 1.5 v","description":"Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29240","name":"Strapping of shoulder","description":"Strapping; shoulder (eg, velpeau)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21125","name":"Augmentation mndblr prostc","description":"Augmentation, mandibular body or angle; prosthetic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2286.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88366","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85598","name":"Hexagnal phosph pltlt neutrl","description":"Phospholipid neutralization; hexagonal phospholipid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87808","name":"Trichomonas assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; trichomonas vaginalis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84120","name":"Assay of urine porphyrins","description":"Porphyrins, urine; quantitation and fractionation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27228","name":"Treat hip fracture(s)","description":"Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes t-fracture and both column fracture with complete articular detachment, or single column or transverse fracture with associated acetabular wall fracture, with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42205","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6011","name":"Collagen gel/paste wound fil","description":"Collagen based wound filler, gel/paste, per gram of collagen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86376","name":"Microsomal antibody each","description":"Microsomal antibodies (eg, thyroid or liver-kidney), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54440","name":"Repair of penis","description":"Plastic operation of penis for injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":754.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3806","name":"Whfo w/joint(s) custom fab","description":"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57280","name":"Suspension of vagina","description":"Colpopexy, abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84060","name":"Assay acid phosphatase","description":"Phosphatase, acid; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51596","name":"Remove bladder/create pouch","description":"Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large intestine to construct neobladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1905.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2530","name":"Thigh/wght bear lacer non-mo","description":"Addition to lower extremity, thigh-weight bearing, lacer, non-molded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"UNK","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":51.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":5.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":78.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":32.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":90.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":44.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":38.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":275.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":62.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]},{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6531","name":"Compress stking bk30-40 surg","description":"Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["AW","GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0291","name":"Hosp bed fx ht w/o rail w/o","description":"Hospital bed, fixed height, without side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49323","name":"Laparo drain lymphocele","description":"Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6207","name":"Contact layer >16<= 48 sq in","description":"Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73620","name":"X-ray exam of foot","description":"Radiologic examination, foot; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47010","name":"Hepatot opn drg absc/cst 1/2","description":"Hepatotomy, for open drainage of abscess or cyst, 1 or 2 stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84144","name":"Assay of progesterone","description":"Progesterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2390","name":"Solid drive wheel tire","description":"Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29863","name":"Hip arthr0 w/synovectomy","description":"Arthroscopy, hip, surgical; with synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73080","name":"X-ray exam of elbow","description":"Radiologic examination, elbow; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13100","name":"Cmplx rpr trunk 1.1-2.5 cm","description":"Repair, complex, trunk; 1.1 cm to 2.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90471","name":"Immunization admin","description":"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8911","name":"Mra w/o fol w/cont, chest","description":"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00580","name":"Anes heart/lung transplant","description":"Anesthesia for heart transplant or heart/lung transplant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56442","name":"Hymenotomy","description":"Hymenotomy, simple incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28118","name":"Removal of heel bone","description":"Ostectomy, calcaneus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27065","name":"Remove hip bone les super","description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; superficial, includes autograft, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69718","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1070.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65815","name":"Drainage of eye","description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50561","name":"Kidney endoscopy & treatment","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0443T","name":"R-t spctrl alys prst8 tiss","description":"Real-time spectral analysis of prostate tissue by fluorescence spectroscopy, including imaging guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77053","name":"X-ray of mammary duct","description":"Mammary ductogram or galactogram, single duct, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27612","name":"Exploration of ankle joint","description":"Arthrotomy, posterior capsular release, ankle, with or without achilles tendon lengthening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":457.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45386","name":"Colonoscopy w/balloon dilat","description":"Colonoscopy, flexible; with transendoscopic balloon dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":470.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15341","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81284","name":"Fxn gene detc abnor alleles","description":"Fxn (frataxin) (eg, friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44136","name":"Intestine transplant live","description":"Intestinal allotransplantation; from living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1299.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87542","name":"Legion pneumo dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); legionella pneumophila, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35184","name":"Rpr cgen av fistula xtr","description":"Repair, congenital arteriovenous fistula; extremities","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77301","name":"Radiotherapy dose plan imrt","description":"Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33512","name":"Cabg vein three","description":"Coronary artery bypass, vein only; 3 coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91037","name":"Esoph imped function test","description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4222","name":"Infusion supplies with pump","description":"Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27702","name":"Reconstruct ankle joint","description":"Arthroplasty, ankle; with implant (total ankle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29883","name":"Arthrs kne srg mnisc rpr m&l","description":"Arthroscopy, knee, surgical; with meniscus repair (medial and lateral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64721","name":"Carpal tunnel surgery","description":"Neuroplasty and/or transposition; median nerve at carpal tunnel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":364.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29834","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50382","name":"Change ureter stent percut","description":"Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":884.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0275","name":"Bed pan standard","description":"Bed pan, standard, metal or plastic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71555","name":"Mri angio chest w or w/o dye","description":"Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":304.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57461","name":"Conz of cervix w/scope leep","description":"Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0860","name":"Tract equip cervical tract","description":"Traction equipment, overdoor, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76496","name":"Unlisted fluoroscopic px","description":"Unlisted fluoroscopic procedure (eg, diagnostic, interventional)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86940","name":"Hemolysins/agglutinins auto","description":"Hemolysins and agglutinins; auto, screen, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61512","name":"Crnec treph exc mngioma sttl","description":"Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46608","name":"Anoscopy remove for body","description":"Anoscopy; with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77307","name":"Telethx isodose plan cplx","description":"Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86023","name":"Immunoglobulin assay","description":"Antibody identification; platelet associated immunoglobulin assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72190","name":"X-ray exam of pelvis","description":"Radiologic examination, pelvis; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31090","name":"Exploration of sinuses","description":"Sinusotomy, unilateral, 3 or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":795.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0498","name":"Holster elec/combo vad, rep","description":"Holster for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13151","name":"Cmplx rpr e/n/e/l 1.1-2.5 cm","description":"Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0565T","name":"Autol cell implt adps hrvg","description":"Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31254","name":"Nsl/sins ndsc w/prtl ethmdct","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92551","name":"Pure tone hearing test air","description":"Screening test, pure tone, air only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33875","name":"Thoracic aortic graft","description":"Descending thoracic aorta graft, with or without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2394.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63044","name":"Laminotomy addl lumbar","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87799","name":"Detect agent nos dna quant","description":"Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; quantification, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95803","name":"Actigraphy testing","description":"Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66500","name":"Incision of iris","description":"Iridotomy by stab incision (separate procedure); except transfixion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33956","name":"Ecmo/ecls insj ctr cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":729.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21557","name":"Resect neck thorax tumor<5cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27590","name":"Amputate leg at thigh","description":"Amputation, thigh, through femur, any level;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":689.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48510","name":"Drain pancreatic pseudocyst","description":"External drainage, pseudocyst of pancreas, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":917.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17280","name":"Dstr mal ls f/e/e/n/l/m .5/<","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22220","name":"Osteot dsc ant 1 vrt sgm crv","description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1452.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49427","name":"Injection abdominal shunt","description":"Injection procedure (eg, contrast media) for evaluation of previously placed peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7404","name":"Add ue prost a/e acrylic","description":"Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":271.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87532","name":"Hhv-6 dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); herpes virus-6, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90865","name":"Narcosynthesis","description":"Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital (amytal) interview)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21044","name":"Removal of jaw bone lesion","description":"Excision of malignant tumor of mandible;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55720","name":"Drainage of prostate abscess","description":"Prostatotomy, external drainage of prostatic abscess, any approach; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":365.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54205","name":"Njx px peyronie ds exps plaq","description":"Injection procedure for peyronie disease; with surgical exposure of plaque","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0694","name":"Uvl md cabinet sys 6 ft","description":"Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82387","name":"Assay of cathepsin-d","description":"Cathepsin-d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76977","name":"Us bone density measure","description":"Ultrasound bone density measurement and interpretation, peripheral site(s), any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63005","name":"Remove spine lamina 1/2 lmbr","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1066.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49492","name":"Rpr ing hern premie blocked","description":"Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":801.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85210","name":"Clot factor ii prothrom spec","description":"Clotting; factor ii, prothrombin, specific","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0627","name":"Lo sag ri an/pos pnl pre cst","description":"Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefab","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46716","name":"Rep perf anoper/vestib fistu","description":"Repair of low imperforate anus; with transposition of anoperineal or anovestibular fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0344","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45505","name":"Repair of rectum","description":"Proctoplasty; for prolapse of mucous membrane","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53660","name":"Dilation of urethra","description":"Dilation of female urethra including suppository and/or instillation; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4395","name":"Ostomy pouch solid deodorant","description":"Ostomy deodorant for use in ostomy pouch, solid, per tablet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88167","name":"Cytopath tbs c/v select","description":"Cytopathology, slides, cervical or vaginal (the bethesda system); with manual screening and computer-assisted rescreening using cell selection and review under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6248","name":"Hydrogel drsg gel filler","description":"Hydrogel dressing, wound filler, gel, per fluid ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37606","name":"Lig int/com carotid art occl","description":"Ligation; internal or common carotid artery, with gradual occlusion, as with selverstone or crutchfield clamp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87324","name":"Clostridium ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; clostridium difficile toxin(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2784","name":"Lens polycarb or equal","description":"Lens, polycarbonate or equal, any index, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31288","name":"Nasal/sinus endoscopy surg","description":"Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0747","name":"Elec osteogen stim not spine","description":"Osteogenesis stimulator, electrical, non-invasive, other than spinal applications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44381","name":"Small bowel endoscopy br/wa","description":"Ileoscopy, through stoma; with transendoscopic balloon dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93298","name":"Rem interrog dev eval scrms","description":"Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0544T","name":"Tcat mv annulus rcnstj","description":"Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78588","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42409","name":"Drainage of salivary cyst","description":"Marsupialization of sublingual salivary cyst (ranula)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75736","name":"Artery x-rays pelvis","description":"Angiography, pelvic, selective or supraselective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22904","name":"Radical resect abd tumor<5cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":906.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2213","name":"Lens sphcyl bifo 7.25-12/4.2","description":"Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16025","name":"Dress/debrid p-thick burn m","description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31296","name":"Nsl/sins ndsc surg frnt sins","description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85810","name":"Blood viscosity examination","description":"Viscosity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48102","name":"Needle biopsy pancreas","description":"Biopsy of pancreas, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27146","name":"Incision of hip bone","description":"Osteotomy, iliac, acetabular or innominate bone;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95015","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75822","name":"Vein x-ray arms/legs","description":"Venography, extremity, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11983","name":"Remove/insert drug implant","description":"Removal with reinsertion, non-biodegradable drug delivery implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27329","name":"Resect thigh/knee tum < 5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27596","name":"Amputation follow-up surgery","description":"Amputation, thigh, through femur, any level; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":616.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38200","name":"Injection for spleen x-ray","description":"Injection procedure for splenoportography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47543","name":"Endoluminal bx biliary tree","description":"Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32445","name":"Removal of lung extrapleural","description":"Removal of lung, pneumonectomy; extrapleural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2839.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23620","name":"Cltx gr hmrl tbrs fx wo mnpj","description":"Closed treatment of greater humeral tuberosity fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":223.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68510","name":"Biopsy of tear gland","description":"Biopsy of lacrimal gland","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6002","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42831","name":"Removal of adenoids","description":"Adenoidectomy, primary; age 12 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87550","name":"Mycobacteria dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria species, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2745","name":"Tint, any color/solid/grad","description":"Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95924","name":"Ans parasymp & symp w/tilt","description":"Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51736","name":"Urine flow measurement","description":"Simple uroflowmetry (ufr) (eg, stop-watch flow rate, mechanical uroflowmeter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46762","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":709.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0900","name":"Trac stand free stand pelvic","description":"Traction stand, free standing, pelvic traction, (e.g., bucks)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2605","name":"Position wc cush wdth <22 in","description":"Positioning wheelchair seat cushion, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42844","name":"Extensive surgery of throat","description":"Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with local flap (eg, tongue, buccal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0452","name":"Molecular pathology interpr","description":"Molecular pathology procedure; physician interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92590","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4258","name":"Lancet device each","description":"Spring-powered device for lancet, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","KL","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36825","name":"Artery-vein autograft","description":"Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":697.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53405","name":"Revise urethra stage 2","description":"Urethroplasty; second stage (formation of urethra), including urinary diversion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":706.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69645","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74010","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6386","name":"Postop ea cast chg & realign","description":"Immediate post surgical or early fitting, each additional cast change and realignment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36901","name":"Intro cath dialysis circuit","description":"Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95712","name":"Veeg 2-12 hr intmt mntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, 2-12 hours; with intermittent monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61798","name":"Srs cranial lesion complex","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 complex cranial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47122","name":"Extensive removal of liver","description":"Hepatectomy, resection of liver; trisegmentectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2874.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87040","name":"Blood culture for bacteria","description":"Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19288","name":"Perq dev breast add mr guide","description":"Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1195","name":"Wheelchair amputee heavy dut","description":"Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49452","name":"Replace g-j tube perc","description":"Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27516","name":"Treat thigh fx growth plate","description":"Closed treatment of distal femoral epiphyseal separation; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31257","name":"Nsl/sins ndsc tot w/sphendt","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76642","name":"Ultrasound breast limited","description":"Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1228","name":"Wheelchair spec sz spec ht b","description":"Special back height for wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2228","name":"Mwc acc, wheelchair brake","description":"Manual wheelchair accessory, wheel braking system and lock, complete, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21356","name":"Opn tx dprsd zygomatic arch","description":"Open treatment of depressed zygomatic arch fracture (eg, gillies approach)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":405.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38531","name":"Open bx/exc inguinofem nodes","description":"Biopsy or excision of lymph node(s); open, inguinofemoral node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":277.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2100","name":"Lens spher single plano 4.00","description":"Sphere, single vision, plano to plus or minus 4.00, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93971","name":"Extremity study","description":"Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87276","name":"Influenza a ag if","description":"Infectious agent antigen detection by immunofluorescent technique; influenza a virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90845","name":"Psychoanalysis","description":"Psychoanalysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63043","name":"Laminotomy addl cervical","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64823","name":"Sympathectomy supfc palmar","description":"Sympathectomy; superficial palmar arch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":667.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28555","name":"Repair foot dislocation","description":"Open treatment of tarsal bone dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12002","name":"Rpr s/n/ax/gen/trnk2.6-7.5cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59001","name":"Amniocentesis therapeutic","description":"Amniocentesis; therapeutic amniotic fluid reduction (includes ultrasound guidance)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8465","name":"Shrinker upper limb","description":"Prosthetic shrinker, upper limb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80172","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31382","name":"Partial removal of larynx","description":"Partial laryngectomy (hemilaryngectomy); antero-latero-vertical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78803","name":"Rp loclzj tum spect 1 area","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect), single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91012","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4532","name":"Ped size pull-on lg","description":"Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57556","name":"Remove cervix repair bowel","description":"Excision of cervical stump, vaginal approach; with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":371.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82960","name":"Test for g6pd enzyme","description":"Glucose-6-phosphate dehydrogenase (g6pd); screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0762","name":"Trans elec jt stim dev sys","description":"Transcutaneous electrical joint stimulation device system, includes all accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70540","name":"Mri orbit/face/neck w/o dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20520","name":"Rmvl fb musc/tdn simple","description":"Removal of foreign body in muscle or tendon sheath; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72083","name":"X-ray exam entire spi 4/5 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 4 or 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0780","name":"Mech amb infusion pump <8hrs","description":"Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70481","name":"Ct orbit/ear/fossa w/dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90885","name":"Psy evaluation of records","description":"Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0108","name":"Diab manage trn  per indiv","description":"Diabetes outpatient self-management training services, individual, per 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11900","name":"Inject skin lesions </w 7","description":"Injection, intralesional; up to and including 7 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88381","name":"Microdissection manual","description":"Microdissection (ie, sample preparation of microscopically identified target); manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0780","name":"Mech amb infusion pump <8hrs","description":"Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57421","name":"Exam/biopsy of vag w/scope","description":"Colposcopy of the entire vagina, with cervix if present; with biopsy(s) of vagina/cervix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28111","name":"Part removal of metatarsal","description":"Ostectomy, complete excision; first metatarsal head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":396.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95812","name":"Eeg 41-60 minutes","description":"Electroencephalogram (eeg) extended monitoring; 41-60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65112","name":"Remove eye/revise socket","description":"Exenteration of orbit (does not include skin graft), removal of orbital contents; with therapeutic removal of bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4050","name":"Replace molded calf lacer","description":"Replace molded calf lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78018","name":"Thyroid met imaging body","description":"Thyroid carcinoma metastases imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95707","name":"Eeg w/o vid 2-12hr cont mntr","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, 2-12 hours; with continuous, real-time monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99404","name":"Prev med cnsl indiv apprx 60","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95910","name":"Nrv cndj test 7-8 studies","description":"Nerve conduction studies; 7-8 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12014","name":"Rpr f/e/e/n/l/m 5.1-7.5 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01756","name":"Anes opn/arthrs elbw rad px","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; radical procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4755","name":"Comb art/venous blood tubing","description":"Blood tubing, arterial and venous combined, for hemodialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57505","name":"Endocervical curettage","description":"Endocervical curettage (not done as part of a dilation and curettage)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00731","name":"Anes upr gi ndsc px nos","description":"Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83912","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96372","name":"Ther/proph/diag inj sc/im","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75959","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95824","name":"Eeg cerebral death only","description":"Electroencephalogram (eeg); cerebral death evaluation only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54250","name":"Nctrnl pen tmscn&/rgdity tst","description":"Nocturnal penile tumescence and/or rigidity test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43810","name":"Gastroduodenostomy","description":"Gastroduodenostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":853.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28039","name":"Exc foot/toe tum sc 1.5 cm/>","description":"Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":403.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87320","name":"Chlmyd trach ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; chlamydia trachomatis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82677","name":"Assay of estriol","description":"Estriol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35634","name":"Bpg iliorenal","description":"Bypass graft, with other than vein; iliorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97608","name":"Neg prs wnd ther ndme>50sqcm","description":"Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surfac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8619","name":"Coch imp ext proc/contr rplc","description":"Cochlear implant, external speech processor and controller, integrated system, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4081.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52310","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62318","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6261","name":"Wound filler gel/paste /oz","description":"Wound filler, gel/paste, per fluid ounce, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66225","name":"Repair/graft eye lesion","description":"Repair of scleral staphyloma with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":559.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57500","name":"Biopsy of cervix","description":"Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78315","name":"Bone imaging 3 phase","description":"Bone and/or joint imaging; 3 phase study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":281.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17264","name":"Dstrj mal les t/a/l 3.1-4.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87102","name":"Fungus isolation culture","description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4235","name":"Lithium batt for glucose mon","description":"Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","KL","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0841","name":"Pwc gp2 std mult pow opt s/b","description":"Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38381","name":"Thoracic duct procedure","description":"Suture and/or ligation of thoracic duct; thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67915","name":"Repair eyelid defect","description":"Repair of ectropion; thermocauterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68100","name":"Biopsy conjunctiva","description":"Biopsy of conjunctiva","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0828","name":"Pwc gp 2 xtra hd seat/back","description":"Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33228","name":"Remv&replc pm gen dual lead","description":"Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":305.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93583","name":"Perq transcath septal reduxn","description":"Percutaneous transcatheter septal reduction therapy (eg, alcohol septal ablation) including temporary pacemaker insertion when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21121","name":"Geniop sldg osteot 1","description":"Genioplasty; sliding osteotomy, single piece","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":540.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26356","name":"Repair finger/hand tendon","description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no mans land); primary, without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95801","name":"Slp stdy unatnd w/anal","description":"Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54505","name":"Biopsy of testis","description":"Biopsy of testis, incisional (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82435","name":"Assay of blood chloride","description":"Chloride; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81180","name":"Atxn3 gene detc abnor allele","description":"Atxn3 (ataxin 3) (eg, spinocerebellar ataxia, machado-joseph disease) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86834","name":"Hla class i semiquant panel","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); semi-quantitative panel (eg, titer), hla class i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21267","name":"Revise eye sockets","description":"Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24343","name":"Repr elbow lat ligmnt w/tiss","description":"Repair lateral collateral ligament, elbow, with local tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":593.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87081","name":"Culture screen only","description":"Culture, presumptive, pathogenic organisms, screening only;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2003","name":"Post-d/c h vst new pt 45 m","description":"Moderate (45 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40510","name":"Partial excision of lip","description":"Excision of lip; transverse wedge excision with primary closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8424","name":"Ready gradient sleeve","description":"Gradient pressure aid (sleeve), ready made","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4429","name":"Urine ost pouch w bltinconv","description":"Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0946","name":"Fracture frame dual w cross","description":"Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51840","name":"Attach bladder/urethra","description":"Anterior vesicourethropexy, or urethropexy (eg, marshall-marchetti-krantz, burch); simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4608","name":"Transtracheal oxygen cath","description":"Transtracheal oxygen catheter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23420","name":"Repair of shoulder","description":"Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":821.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0501","name":"Shwr cov elec/combo vad, rep","description":"Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87301","name":"Adenovirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; adenovirus enteric types 40/41","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64566","name":"Neuroeltrd stim post tibial","description":"Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48146","name":"Pancreatectomy","description":"Pancreatectomy, distal, near-total with preservation of duodenum (child-type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78231","name":"Salivary glnd img serial img","description":"Salivary gland imaging; with serial images","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33220","name":"Repair lead pace-defib dual","description":"Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83012","name":"Assay of haptoglobins","description":"Haptoglobin; phenotypes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46030","name":"Removal anal seton oth mrk","description":"Removal of anal seton, other marker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36002","name":"Pseudoaneurysm injection trt","description":"Injection procedures (eg, thrombin) for percutaneous treatment of extremity pseudoaneurysm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2610","name":"Hip clevis/thrust bearing lo","description":"Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25150","name":"Partial removal of ulna","description":"Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50010","name":"Renal exploration","description":"Renal exploration, not necessitating other specific procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33982","name":"Replace vad intra w/o bp","description":"Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1706.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86078","name":"Phys blood bank serv reactj","description":"Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1233","name":"Rig ped wc tltnspc w/o seat","description":"Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73220","name":"Mri uppr extremity w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96374","name":"Ther/proph/diag inj iv push","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33981","name":"Replace vad pump ext","description":"Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":726.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94450","name":"Breathing response hypoxia","description":"Breathing response to hypoxia (hypoxia response curve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82044","name":"Ur albumin semiquantitative","description":"Albumin; urine (eg, microalbumin), semiquantitative (eg, reagent strip assay)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28092","name":"Removal of toe lesions","description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":343.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28306","name":"Incision of metatarsal","description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72142","name":"Mri neck spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83661","name":"L/s ratio fetal lung","description":"Fetal lung maturity assessment; lecithin sphingomyelin (l/s) ratio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75561","name":"Cardiac mri for morph w/dye","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43300","name":"Repair of esophagus","description":"Esophagoplasty (plastic repair or reconstruction), cervical approach; without repair of tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22212","name":"Incis 1 vertebral seg thorac","description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1305.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69905","name":"Remove inner ear","description":"Labyrinthectomy; transcanal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2755","name":"Uv lens/es","description":"U-v lens, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"R0070","name":"Transport portable x-ray","description":"Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77072","name":"Bone age studies","description":"Bone age studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0820","name":"Pwc gp 2 std port seat/back","description":"Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58600","name":"Division of fallopian tube","description":"Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31595","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74712","name":"Mri fetal sngl/1st gestation","description":"Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":296.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29055","name":"Appl cast shoulder spica","description":"Application, cast; shoulder spica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86765","name":"Rubeola antibody","description":"Antibody; rubeola","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70371","name":"Speech evaluation complex","description":"Complex dynamic pharyngeal and speech evaluation by cine or video recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7009","name":"Adult electric hook","description":"Electric hook, switch or myoelectric controlled, adult","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1845.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45349","name":"Sigmoidoscopy w/resection","description":"Sigmoidoscopy, flexible; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93740","name":"Temperature gradient studies","description":"Temperature gradient studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79445","name":"Nuclear rx intra-arterial","description":"Radiopharmaceutical therapy, by intra-arterial particulate administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8659","name":"Interphalangeal joint repl","description":"Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":940.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75970","name":"Vascular biopsy","description":"Transcatheter biopsy, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0910","name":"Trapeze bar attached to bed","description":"Trapeze bars, a/k/a patient helper, attached to bed, with grab bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61880","name":"Revise/remove neuroelectrode","description":"Revision or removal of intracranial neurostimulator electrodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92577","name":"Stenger test speech","description":"Stenger test, speech","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29914","name":"Hip arthro w/femoroplasty","description":"Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2782","name":"Lens, 1.54-1.65 p/1.60-1.79g","description":"Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00792","name":"Anes iper upr abd prtl hptc","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage (excluding liver biopsy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58346","name":"Insert heyman uteri capsule","description":"Insertion of heyman capsules for clinical brachytherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44346","name":"Revision of colostomy","description":"Revision of colostomy; with repair of paracolostomy hernia (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":971.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99204","name":"Office o/p new mod 45 min","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 45 minutes must be met or excee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2389","name":"Foam caster tire","description":"Power wheelchair accessory, foam caster tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97597","name":"Dbrdmt opn wnd 1st 20 cm/<","description":"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when perform","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2186","name":"Adj motion knee jnt lerman t","description":"Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4422","name":"Ost pouch absorbent material","description":"Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33238","name":"Remove electrode/thoracotomy","description":"Removal of permanent transvenous electrode(s) by thoracotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67042","name":"Vit for macular hole","description":"Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32095","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23552","name":"Optx acrclv dslc aq/chrn grf","description":"Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T5999","name":"Supply, nos","description":"Supply, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64896","name":"Nrv grf mltst hnd/foot >4 cm","description":"Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1215.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61735","name":"Incise skull/brain surgery","description":"Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; subcortical structure(s) other than globus pallidus or thalamus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59852","name":"Induced abortion 1+njx hyst","description":"Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed intra-amniotic injection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27707","name":"Osteotomy fibula","description":"Osteotomy; fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2304","name":"Lens sphcy trifocal 4.0/2.25","description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 2.25-4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95967","name":"Meg evoked each addl","description":"Magnetoencephalography (meg), recording and analysis; for evoked magnetic fields, each additional modality (eg, sensory, motor, language, or visual cortex localization) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":741.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64612","name":"Destroy nerve face muscle","description":"Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6541","name":"Gc stocking waistlngth 40+","description":"Gradient compression stocking, waist length, 40 mmhg or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19303","name":"Mast simple complete","description":"Mastectomy, simple, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61650","name":"Evasc prlng admn rx agnt 1st","description":"Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":503.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53085","name":"Drainage of urinary leakage","description":"Drainage of perineal urinary extravasation; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92587","name":"Evoked auditory test limited","description":"Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2531","name":"Contact lens gas permeable","description":"Contact lens, scleral, gas permeable, per lens (for contact lens modification, see 92325)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0245","name":"Tub stool or bench","description":"Tub stool or bench","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90889","name":"Preparation of report","description":"Preparation of report of patients psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42440","name":"Excise submaxillary gland","description":"Excision of submandibular (submaxillary) gland","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0984","name":"Protect body sock ea pre ots","description":"Protective body sock, prefabricated, off-the-shelf, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64755","name":"Incision of stomach nerves","description":"Transection or avulsion of; vagus nerves limited to proximal stomach (selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":807.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21432","name":"Optx cranfcl sep w/wiring","description":"Open treatment of craniofacial separation (lefort iii type); with wiring and/or internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":600.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61000","name":"Remove cranial cavity fluid","description":"Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95251","name":"Cont gluc mntr analysis i&r","description":"Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84600","name":"Assay of volatiles","description":"Volatiles (eg, acetic anhydride, diethylether)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97530","name":"Therapeutic activities","description":"Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91013","name":"Esophgl motil w/stim/perfus","description":"Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion (eg, stimulant, acid or alkali perfusion) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25820","name":"Arthrd wrist lmtd w/o b1 grf","description":"Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":526.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99345","name":"Home/res vst new high mdm 75","description":"Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96001","name":"Motion test w/ft press meas","description":"Comprehensive computer-based motion analysis by video-taping and 3d kinematics; with dynamic plantar pressure measurements during walking","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61332","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1790.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95925","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2015","name":"Post-d/c care plan overs 60m","description":"Comprehensive (60 mins) home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0195","name":"Elevating whlchair leg rests","description":"Elevating leg rests, pair (for use with capped rental wheelchair base)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29750","name":"Wedging of clubfoot cast","description":"Wedging of clubfoot cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15830","name":"Exc excessive skin abdomen","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52235","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; medium bladder tumor(s) (2.0 to 5.0 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65260","name":"Remove foreign body from eye","description":"Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior route","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54015","name":"I&d penis deep","description":"Incision and drainage of penis, deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50980","name":"Ureter endoscopy & treatment","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37618","name":"Ligation major artery xtr","description":"Ligation, major artery (eg, post-traumatic, rupture); extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64581","name":"Opn impltj nea sacral nerve","description":"Open implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":541.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11008","name":"Rmv prstc mtrl/mesh abd wall","description":"Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65093","name":"Revise eye with implant","description":"Evisceration of ocular contents; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":413.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83505","name":"Assay total hydroxyproline","description":"Hydroxyproline; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47350","name":"Repair liver wound","description":"Management of liver hemorrhage; simple suture of liver wound or injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5696","name":"Ak/knee disartic pelvic join","description":"Addition to lower extremity, above knee or knee disarticulation, pelvic joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0444","name":"Depression screen annual","description":"Annual depression screening, 5 to 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45381","name":"Colonoscopy submucous njx","description":"Colonoscopy, flexible; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01852","name":"Anes px vn f/arm phlbrrhaphy","description":"Anesthesia for procedures on veins of forearm, wrist, and hand; phleborrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21013","name":"Exc face tum deep < 2 cm","description":"Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); less than 2 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":436.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57105","name":"Biopsy vaginal mucosa xtnsv","description":"Biopsy of vaginal mucosa; extensive, requiring suture (including cysts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51550","name":"Partial removal of bladder","description":"Cystectomy, partial; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1685","name":"Post-op hip abduct custom fa","description":"Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26607","name":"Treat metacarpal fracture","description":"Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2603","name":"Skin protect wc cus wd <22in","description":"Skin protection wheelchair seat cushion, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33677","name":"Cl mult vsd w/rem pul band","description":"Closure of multiple ventricular septal defects; with removal of pulmonary artery band, with or without gusset","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65855","name":"Trabeculoplasty laser surg","description":"Trabeculoplasty by laser surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94060","name":"Evaluation of wheezing","description":"Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1100","name":"Ring flange plastic/leather","description":"Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47362","name":"Repair liver wound","description":"Management of liver hemorrhage; re-exploration of hepatic wound for removal of packing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1215.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0198","name":"Water pressure pad for mattr","description":"Water pressure pad for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3935","name":"Fo nontorsion joint cf","description":"Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84119","name":"Test urine for porphyrins","description":"Porphyrins, urine; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1092","name":"Wheelchair wide w/ leg rests","description":"Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94453","name":"Hast w/suppl oxygen titrj","description":"High altitude simulation test (hast), with interpretation and report by a physician or other qualified health care professional; with supplemental oxygen titration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83593","name":"Fractionation ketosteroids","description":"Ketosteroids, 17- (17-ks); fractionation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9685","name":"Acute nursing facility care","description":"Physician service or other qualified health care professional for the evaluation and management of a beneficiarys acute change in condition in a nursing facility. this service is for a demonstration project","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47541","name":"Plmt access bil tree sm bwl","description":"Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological superv","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":931.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24151","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":839.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21120","name":"Genioplasty augmentation","description":"Genioplasty; augmentation (autograft, allograft, prosthetic material)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":552.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4510","name":"Full length surg stocking","description":"Surgical stockings full length, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3995","name":"Sock fracture or equal each","description":"Addition to upper extremity orthosis, sock, fracture or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73010","name":"X-ray exam of shoulder blade","description":"Radiologic examination; scapula, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P3000","name":"Screen pap by tech w md supv","description":"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10021","name":"Fna bx w/o img gdn 1st les","description":"Fine needle aspiration biopsy, without imaging guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4618","name":"Breathing circuits","description":"Breathing circuits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84439","name":"Assay of free thyroxine","description":"Thyroxine; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3675","name":"So vest canvas/web pre ots","description":"Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2204","name":"Frame depth 22 to 25 in","description":"Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7015","name":"Aerosol mask used w nebulize","description":"Aerosol mask, used with dme nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99145","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1815","name":"Adjust ankle ext & flex dev","description":"Dynamic adjustable ankle extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0174","name":"Cerv sr 2pc thor ext pre ots","description":"Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26117","name":"Rad resect hand tumor < 3 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":624.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0329","name":"Electromagntic tx for ulcers","description":"Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4639","name":"Infrared ht sys replcmnt pad","description":"Replacement pad for infrared heating pad system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67115","name":"Release encircling material","description":"Release of encircling material (posterior segment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28010","name":"Incision of toe tendon","description":"Tenotomy, percutaneous, toe; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0516","name":"Insert drug del implant, >=4","description":"Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92610","name":"Evaluate swallowing function","description":"Evaluation of oral and pharyngeal swallowing function","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36450","name":"Bld exchange truj newborn","description":"Exchange transfusion, blood; newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2612","name":"Gen use back cush wdth>=22in","description":"General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0838","name":"Pwc gp 2 hd sing pow opt cap","description":"Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0320","name":"Two-way audio and video hhs","description":"Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50435","name":"Exchange nephrostomy cath","description":"Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":453.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32671","name":"Thoracoscopy pneumonectomy","description":"Thoracoscopy, surgical; with removal of lung (pneumonectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23616","name":"Optx prx hmrl fx fix rpr rpl","description":"Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed; with proximal humeral prosthetic replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1630","name":"Abduct control hip semi-flex","description":"Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27681","name":"Release of lower leg tendons","description":"Tenolysis, flexor or extensor tendon, leg and/or ankle; multiple tendons (through separate incision[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87495","name":"Cytomeg dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); cytomegalovirus, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5450","name":"Postop app non-wgt bear dsg","description":"Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44392","name":"Colonoscopy & polypectomy","description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76380","name":"Cat scan follow-up study","description":"Computed tomography, limited or localized follow-up study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27816","name":"Treatment of ankle fracture","description":"Closed treatment of trimalleolar ankle fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22512","name":"Vertebroplasty addl inject","description":"Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49521","name":"Rerepair ing hernia blocked","description":"Repair recurrent inguinal hernia, any age; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77076","name":"Radex osseous survey infant","description":"Radiologic examination, osseous survey, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36565","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; without subcutaneous port or pump (eg, tesio type catheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44203","name":"Lap resect s/intestine addl","description":"Laparoscopy, surgical; each additional small intestine resection and anastomosis (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61868","name":"Implant neuroelectrde addl","description":"Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; each additional ar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":462.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27045","name":"Exc hip/pelv tum deep 5 cm/>","description":"Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63664","name":"Revise spine eltrd plate","description":"Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63051","name":"C-laminoplasty w/graft/plate","description":"Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [eg, wire, suture, mini-plates], when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1507.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73523","name":"X-ray exam hips bi 5/> views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4378","name":"Drainable rubber pch w/o fp","description":"Ostomy pouch, drainable, for use on faceplate, rubber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35663","name":"Bpg ilioiliac","description":"Bypass graft, with other than vein; ilioiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86153","name":"Cell enumeration phys interp","description":"Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58560","name":"Hysteroscopy resect septum","description":"Hysteroscopy, surgical; with division or resection of intrauterine septum (any method)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99479","name":"Sbsq ic lbw inf 1,500-2,500","description":"Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant (present body weight of 1,500-2,500 grams)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82565","name":"Assay of creatinine","description":"Creatinine; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01212","name":"Anes open px hip jt disrtcj","description":"Anesthesia for open procedures involving hip joint; hip disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0208T","name":"Audiometry air only","description":"Pure tone audiometry (threshold), automated; air only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6013","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65450","name":"Treatment of corneal lesion","description":"Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4526","name":"Adult size pull-on med","description":"Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20560","name":"Ndl insj w/o njx 1 or 2 musc","description":"Needle insertion(s) without injection(s); 1 or 2 muscle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83945","name":"Assay of oxalate","description":"Oxalate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42700","name":"I&d abscess peritonsillar","description":"Incision and drainage abscess; peritonsillar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96521","name":"Refill/maint portable pump","description":"Refilling and maintenance of portable pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87555","name":"M.tuberculo dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria tuberculosis, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47544","name":"Removal duct glbldr calculi","description":"Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (list sep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44150","name":"Removal of colon","description":"Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95977","name":"Alys cplx cn npgt prgrmg","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22551","name":"Arthrd ant ntrbdy cervical","description":"Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below c2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1524.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76946","name":"Echo guide for amniocentesis","description":"Ultrasonic guidance for amniocentesis, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87260","name":"Adenovirus ag if","description":"Infectious agent antigen detection by immunofluorescent technique; adenovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46754","name":"Removal of suture from anus","description":"Removal of thiersch wire or suture, anal canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46606","name":"Anoscopy and biopsy","description":"Anoscopy; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77295","name":"3-d radiotherapy plan","description":"3-dimensional radiotherapy plan, including dose-volume histograms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67030","name":"Incise inner eye strands","description":"Discission of vitreous strands (without removal), pars plana approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":328.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75746","name":"Artery x-rays lung","description":"Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00563","name":"Anes px heart w/pmp crc arst","description":"Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9985","name":"Remote e/m est. pt 25mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history;  a detailed exam","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97605","name":"Neg prs wnd ther dme<=50sqcm","description":"Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (dme), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51610","name":"Injection for bladder x-ray","description":"Injection procedure for retrograde urethrocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93279","name":"Prgrmg dev eval pm/ldls pm","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31085","name":"Removal of frontal sinus","description":"Sinusotomy frontal; obliterative, with osteoplastic flap, coronal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":908.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25695","name":"Optx lunate dislocation","description":"Open treatment of lunate dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6206","name":"Contact layer <= 16 sq in","description":"Contact layer, sterile, 16 sq. in. or less, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58290","name":"Vag hyst complex","description":"Vaginal hysterectomy, for uterus greater than 250 g;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2275","name":"Plastic mod low ext pad/line","description":"Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0911","name":"Hd trapeze bar attach to bed","description":"Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48001","name":"Placement of drain pancreas","description":"Placement of drains, peripancreatic, for acute pancreatitis; with cholecystostomy, gastrostomy, and jejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1941.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94619","name":"Exercise tst brncspsm wo ecg","description":"Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; without electrocardiographic recording(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33779","name":"Rpr tga rcnstj rmvl plm bnd","description":"Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, jatene type); with removal of pulmonary band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74182","name":"Mri abdomen w/contrast","description":"Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4461","name":"Surgicl dress hold non-reuse","description":"Surgical dressing holder, non-reusable, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64492","name":"Inj paravert f jnt c/t 3 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), cervical or thoracic; third and any additional level(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82550","name":"Assay of ck (cpk)","description":"Creatine kinase (ck), (cpk); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41018","name":"Drainage of mouth lesion","description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; masticator space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28041","name":"Exc foot/toe tum dep 1.5cm/>","description":"Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); 1.5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0615","name":"Pacemaker monitr digital/vis","description":"Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0330T","name":"Tear film img uni/bi w/i&r","description":"Tear film imaging, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19296","name":"Place po breast cath for rad","description":"Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2509.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29900","name":"Mcp joint arthroscopy dx","description":"Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37213","name":"Thromblytic art/ven therapy","description":"Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27591","name":"Amputate leg at thigh","description":"Amputation, thigh, through femur, any level; immediate fitting technique including first cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":817.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37224","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1722.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99498","name":"Advncd care plan addl 30 min","description":"Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (list separately in addition to code for primary proce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83788","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91313","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01200","name":"Anes all closed px hip joint","description":"Anesthesia for all closed procedures involving hip joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36565","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; without subcutaneous port or pump (eg, tesio type catheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":724.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2320","name":"Lens trifocal add over 3.25d","description":"Trifocal add over 3.25d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35241","name":"Rpr blvsl vn grf ntrthrc w/b","description":"Repair blood vessel with vein graft; intrathoracic, with bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76856","name":"Us exam pelvic complete","description":"Ultrasound, pelvic (nonobstetric), real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80434","name":"Insulin tolerance panel","description":"Insulin tolerance panel; for acth insufficiency this panel must include the following: cortisol (82533 x 5) glucose (82947 x 5)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5122","name":"Solid skin barrier 8x8","description":"Skin barrier; solid, 8 x 8 or equivalent, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8606","name":"Synthetic implnt urinary 1ml","description":"Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27370","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62324","name":"Njx interlaminar crv/thrc","description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thorac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00632","name":"Anes px lumbar sympathectomy","description":"Anesthesia for procedures in lumbar region; lumbar sympathectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10121","name":"Inc&rmvl fb subq tiss comp","description":"Incision and removal of foreign body, subcutaneous tissues; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92556","name":"Speech audiometry complete","description":"Speech audiometry threshold; with speech recognition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01933","name":"Anes ther ivntl rad px icr","description":"Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intracranial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24006","name":"Arthrt elbw capsl exc rls","description":"Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54405","name":"Insert multi-comp penis pros","description":"Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88344","name":"Imhchem/imcytchm ea mlt antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94453","name":"Hast w/suppl oxygen titrj","description":"High altitude simulation test (hast), with interpretation and report by a physician or other qualified health care professional; with supplemental oxygen titration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23406","name":"Incise tendon(s) & muscle(s)","description":"Tenotomy, shoulder area; multiple tendons through same incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0249T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36905","name":"Thrmbc/nfs dialysis circuit","description":"Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thromboly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33910","name":"Remove lung artery emboli","description":"Pulmonary artery embolectomy; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2325.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0610","name":"Pacemaker monitr audible/vis","description":"Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40812","name":"Excise/repair mouth lesion","description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":220.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33979","name":"Insert intracorporeal device","description":"Insertion of ventricular assist device, implantable intracorporeal, single ventricle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27080","name":"Removal of tail bone","description":"Coccygectomy, primary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96119","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25440","name":"Repair nonu scphd carpl b1","description":"Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8509","name":"Trach-esoph voice pros md in","description":"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0170","name":"Cervical collar molded to pt","description":"Cervical, collar, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81120","name":"Idh1 common variants","description":"Idh1 (isocitrate dehydrogenase 1 [nadp+], soluble) (eg, glioma), common variants (eg, r132h, r132c)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1904","name":"Afo molded ankle gauntlet","description":"Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6713","name":"Ped term dev, hand, vol open","description":"Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63295","name":"Repair laminectomy defect","description":"Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69676","name":"Remove middle ear nerve","description":"Tympanic neurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":669.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29065","name":"Appl cst sho to hand lng arm","description":"Application, cast; shoulder to hand (long arm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21032","name":"Remove exostosis maxilla","description":"Excision of maxillary torus palatinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1233","name":"Rig ped wc tltnspc w/o seat","description":"Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58548","name":"Lap radical hyst","description":"Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41251","name":"Repair tongue laceration","description":"Repair of laceration 2.5 cm or less; posterior one-third of tongue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87802","name":"Strep b assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; streptococcus, group b","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29584","name":"Appl mltlay cmprn sys up arm","description":"Application of multi-layer compression system; upper arm, forearm, hand, and fingers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","name":"Lipid panel","description":"Lipid panel this panel must include the following: cholesterol, serum, total (82465) lipoprotein, direct measurement, high density cholesterol (hdl cholesterol) (83718) triglycerides (84478)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2120","name":"Pulse gen sys tx endolymp fl","description":"Pulse generator system for tympanic treatment of inner ear endolymphatic fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63700","name":"Repair of spinal herniation","description":"Repair of meningocele; less than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35190","name":"Repair acq av fistula xtr","description":"Repair, acquired or traumatic arteriovenous fistula; extremities","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96932","name":"Rcm img acquisj only 1st les","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition only, first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46947","name":"Hemorrhoidopexy by stapling","description":"Hemorrhoidopexy (eg, for prolapsing internal hemorrhoids) by stapling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11011","name":"Debride skin musc at fx site","description":"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63103","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic or lumbar, each additional segment (list separately in addition to code for primary proc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31800","name":"Repair of windpipe injury","description":"Suture of tracheal wound or injury; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":534.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25316","name":"Revise palsy hand tendon(s)","description":"Flexor origin slide (eg, for cerebral palsy, volkmann contracture), forearm and/or wrist; with tendon(s) transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":773.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0880","name":"Pwc gp4 vhd sing pow opt s/b","description":"Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21720","name":"Revision of neck muscle","description":"Division of sternocleidomastoid for torticollis, open operation; without cast application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95852","name":"Range of motion measurements","description":"Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99468","name":"Neonate crit care initial","description":"Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":753.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8270","name":"Enuresis alarm","description":"Enuresis alarm, using auditory buzzer and/or vibration device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6110","name":"Elbow mold sock suspension t","description":"Below elbow, molded socket, (muenster or northwestern suspension types)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1350.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29889","name":"Arthrs aid pcl rpr/agmntj","description":"Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23655","name":"Cltx sho dslc w/mnpj w/anes","description":"Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0502","name":"Mobility cart pneum vad, rep","description":"Mobility cart for pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58671","name":"Laparoscopy tubal block","description":"Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or falope ring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90836","name":"Psytx w pt w e/m 45 min","description":"Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46060","name":"I&d ischiorectal/ntrmrl absc","description":"Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, with or without placement of seton","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43775","name":"Lap sleeve gastrectomy","description":"Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98966","name":"Ph1 assmt&mgmt nqhp 5-10","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31553","name":"Laryngoplasty laryngeal sten","description":"Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1256.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95925","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71100","name":"X-ray exam ribs uni 2 views","description":"Radiologic examination, ribs, unilateral; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45332","name":"Sigmoidoscopy w/fb removal","description":"Sigmoidoscopy, flexible; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46924","name":"Destruction anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12051","name":"Intmd rpr face/mm 2.5 cm/<","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":168.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0497T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87305","name":"Aspergillus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; aspergillus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1902","name":"Afo ankle gauntlet pre ots","description":"Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5973","name":"Ank-foot sys dors-plant flex","description":"Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8476.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28070","name":"Removal of foot joint lining","description":"Synovectomy; intertarsal or tarsometatarsal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58573","name":"Tlh w/t/o uterus over 250 g","description":"Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":774.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45390","name":"Colonoscopy w/resection","description":"Colonoscopy, flexible; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1200","name":"Wheelchair amputee fixed arm","description":"Amputee wheelchair, fixed full length arms, swing away detachable footrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26820","name":"Thumb fusion with graft","description":"Fusion in opposition, thumb, with autogenous graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":670.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26550","name":"Pollicization digit","description":"Pollicization of a digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1386.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71100","name":"X-ray exam ribs uni 2 views","description":"Radiologic examination, ribs, unilateral; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0277","name":"Powered pres-redu air mattrs","description":"Powered pressure-reducing air mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93246","name":"Ext ecg>7d<15d recording","description":"External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; recording (includes connection and initial recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3485","name":"Shoe heel pad removable for","description":"Heel, pad, removable for spur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50770","name":"Splicing of ureters","description":"Transureteroureterostomy, anastomosis of ureter to contralateral ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31629","name":"Bronchoscopy/needle bx each","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":332.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92609","name":"Use of speech device service","description":"Therapeutic services for the use of speech-generating device, including programming and modification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4405","name":"Nonpectin based ostomy paste","description":"Ostomy skin barrier, non-pectin based, paste, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20910","name":"Remove cartilage for graft","description":"Cartilage graft; costochondral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85220","name":"Blooc clot factor v test","description":"Clotting; factor v (acg or proaccelerin), labile factor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4245","name":"Alcohol wipes per box","description":"Alcohol wipes, per box","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21243","name":"Reconstruction of jaw joint","description":"Arthroplasty, temporomandibular joint, with prosthetic joint replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1309.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30915","name":"Ligation nasal sinus artery","description":"Ligation arteries; ethmoidal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":440.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12021","name":"Tx supfc wnd dehsn w/packing","description":"Treatment of superficial wound dehiscence; with packing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15821","name":"Blepharp lwr eyelid fat pad","description":"Blepharoplasty, lower eyelid; with extensive herniated fat pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":374.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84166","name":"Protein e-phoresis/urine/csf","description":"Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, csf)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43118","name":"Partial removal of esophagus","description":"Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3028.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37207","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0808","name":"Pov group 2 vhd 451-600 lbs","description":"Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4333","name":"Urinary cath anchor device","description":"Urinary catheter anchoring device, adhesive skin attachment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66605","name":"Removal of iris","description":"Iridectomy, with corneoscleral or corneal section; with cyclectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":648.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27696","name":"Repair of ankle ligaments","description":"Repair, primary, disrupted ligament, ankle; both collateral ligaments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36482","name":"Endoven ther chem adhes 1st","description":"Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43415","name":"Repair esophagus wound","description":"Suture of esophageal wound or injury; transthoracic or transabdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28298","name":"Cor hlx vlgs prx phlx osteot","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal phalanx osteotomy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":685.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31241","name":"Nsl/sns ndsc lig sphnptn art","description":"Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15788","name":"Chemical peel facial epidrm","description":"Chemical peel, facial; epidermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44186","name":"Lap jejunostomy","description":"Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":542.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52250","name":"Cystoscopy and radiotracer","description":"Cystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43249","name":"Esoph egd dilation <30 mm","description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9980","name":"Remote e/m new pt 30 mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33681","name":"Closure 1 vsd w/wo patch","description":"Closure of single ventricular septal defect, with or without patch;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97162","name":"Pt eval mod complex 30 min","description":"Physical therapy evaluation: moderate complexity, requiring these components: a history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; an examination of body systems using standardized tests and measures in addressing a total of 3 or more elements fro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10060","name":"I&d abscess simple/single","description":"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28505","name":"Treat big toe fracture","description":"Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66770","name":"Removal of inner eye lesion","description":"Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87335","name":"E coli 0157 ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; escherichia coli 0157","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27454","name":"Realignment of thigh bone","description":"Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (eg, sofield type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1098.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60271","name":"Removal of thyroid","description":"Thyroidectomy, including substernal thyroid; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":890.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84430","name":"Assay of thiocyanate","description":"Thiocyanate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99359","name":"Prolong serv w/o contact add","description":"Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (list separately in addition to code for prolonged service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86663","name":"Epstein-barr antibody","description":"Antibody; epstein-barr (eb) virus, early antigen (ea)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69110","name":"Remove external ear partial","description":"Excision external ear; partial, simple repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76642","name":"Ultrasound breast limited","description":"Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84132","name":"Assay of serum potassium","description":"Potassium; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93350","name":"Stress tte only","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5630","name":"Syme typ expandabl wall sckt","description":"Addition to lower extremity, symes type, expandable wall socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75825","name":"Vein x-ray trunk","description":"Venography, caval, inferior, with serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6130","name":"Elbow stump activated lock h","description":"Below elbow, molded double wall split socket, stump activated locking hinge, half cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1588.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54300","name":"Revision of penis","description":"Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95851","name":"Range of motion measurements","description":"Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77083","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11045","name":"Dbrdmt subq tiss each addl","description":"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33951","name":"Ecmo/ecls insj prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":370.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69000","name":"Drg xtrnl ear absc/hem smpl","description":"Drainage external ear, abscess or hematoma; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87555","name":"M.tuberculo dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria tuberculosis, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1840","name":"Ko derot ant cruciate custom","description":"Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":482.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2780","name":"Non-corrosive finish","description":"Addition to lower extremity orthosis, non-corrosive finish, per bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21146","name":"Rcnstj mdfc lefort i 2 w/grf","description":"Reconstruction midface, lefort i; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24931","name":"Amputate upper arm & implant","description":"Amputation, arm through humerus; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":789.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93610","name":"Intra-atrial pacing","description":"Intra-atrial pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22102","name":"Remove part lumbar vertebra","description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88235","name":"Tissue culture placenta","description":"Tissue culture for non-neoplastic disorders; amniotic fluid or chorionic villus cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36578","name":"Replace tunneled cv cath","description":"Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63173","name":"Drainage of spinal cyst","description":"Laminectomy with drainage of intramedullary cyst/syrinx; to peritoneal or pleural space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93350","name":"Stress tte only","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34471","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; subclavian vein, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":585.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67902","name":"Repair eyelid defect","description":"Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86021","name":"Wbc antibody identification","description":"Antibody identification; leukocyte antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92588","name":"Evoked auditory tst complete","description":"Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45915","name":"Remove rectal obstruction","description":"Removal of fecal impaction or foreign body (separate procedure) under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78650","name":"Csf leakage imaging","description":"Cerebrospinal fluid leakage detection and localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":223.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69511","name":"Extensive mastoid surgery","description":"Mastoidectomy; radical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4326","name":"Male external catheter","description":"Male external catheter with integral collection chamber, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89050","name":"Body fluid cell count","description":"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51726","name":"Complex cystometrogram","description":"Complex cystometrogram (ie, calibrated electronic equipment);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91013","name":"Esophgl motil w/stim/perfus","description":"Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion (eg, stimulant, acid or alkali perfusion) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86280","name":"Hemagglutination inhibition","description":"Hemagglutination inhibition test (hai)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0210U","name":"Syphilis tst antb ia quan 5","description":"Syphilis tst antb ia quan 5","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87389","name":"Hiv-1 ag w/hiv-1&-2 ab ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hiv-1 antigen(s), with hiv-1 and hiv-2 antibodies, single resu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95925","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78202","name":"Liver imaging with vasc flow","description":"Liver imaging; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99475","name":"Ped crit care age 2-5 init","description":"Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5648","name":"Above knee cushion socket","description":"Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28415","name":"Optx calcaneal fracture","description":"Open treatment of calcaneal fracture, includes internal fixation, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20561","name":"Ndl insj w/o njx 3+ musc","description":"Needle insertion(s) without injection(s); 3 or more muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88369","name":"M/phmtrc alysishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0065","name":"Spoke protectors","description":"Spoke protectors, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82383","name":"Assay blood catecholamines","description":"Catecholamines; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57120","name":"Colpocleisis le fort type","description":"Colpocleisis (le fort type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93656","name":"Compre ep eval abltj atr fib","description":"Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, and intracardiac catheter ablation of atrial fibrillation by ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1199.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28200","name":"Repair of foot tendon","description":"Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":401.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20552","name":"Njx 1/mlt trigger point 1/2","description":"Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83902","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94375","name":"Respiratory flow volume loop","description":"Respiratory flow volume loop","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28430","name":"Cltx talus fracture w/o mnpj","description":"Closed treatment of talus fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82492","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44705","name":"Prepare fecal microbiota","description":"Preparation of fecal microbiota for instillation, including assessment of donor specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78609","name":"Brain imaging (pet)","description":"Brain imaging, positron emission tomography (pet); perfusion evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21932","name":"Exc back tum deep < 5 cm","description":"Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27405","name":"Repair of knee ligament","description":"Repair, primary, torn ligament and/or capsule, knee; collateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":569.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5540","name":"Prep bk ptb laminated socket","description":"Preparatory, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":898.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30100","name":"Intranasal biopsy","description":"Biopsy, intranasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40831","name":"Repair mouth laceration","description":"Closure of laceration, vestibule of mouth; over 2.5 cm or complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6445","name":"Conform band s w <3in/yd","description":"Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28737","name":"Revision of foot bones","description":"Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicular-cuneiform (eg, miller type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92557","name":"Comprehensive hearing test","description":"Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80102","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4258","name":"Lancet device each","description":"Spring-powered device for lancet, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","KL","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21083","name":"Impres&prep paltl lft prosth","description":"Impression and custom preparation; palatal lift prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33724","name":"Repair venous anomaly","description":"Repair of isolated partial anomalous pulmonary venous return (eg, scimitar syndrome)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23545","name":"Cltx acromclav dislc w/mnpj","description":"Closed treatment of acromioclavicular dislocation; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96935","name":"Rcm img acquisj only ea addl","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition only, each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6258","name":"Transparent film >16<=48 in","description":"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50290","name":"Excision perinephric cyst","description":"Excision of perinephric cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":726.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5113","name":"Latex leg strap","description":"Leg strap; latex, replacement only, per set","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7036","name":"Pos airway press chinstrap","description":"Chinstrap used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20664","name":"Appl halo cranial 6+pins","description":"Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57461","name":"Conz of cervix w/scope leep","description":"Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76140","name":"X-ray consultation","description":"Consultation on x-ray examination made elsewhere, written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67015","name":"Release of eye fluid","description":"Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1238","name":"Fld ped wc adjstabl w/o seat","description":"Wheelchair, pediatric size, folding, adjustable, without seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00529","name":"Anes clsd ch mediast&thrc w/","description":"Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20972","name":"Bone/skin graft metatarsal","description":"Free osteocutaneous flap with microvascular anastomosis; metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2421.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83605","name":"Assay of lactic acid","description":"Lactate (lactic acid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23616","name":"Optx prx hmrl fx fix rpr rpl","description":"Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed; with proximal humeral prosthetic replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1046.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27443","name":"Revision of knee joint","description":"Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81271","name":"Htt gene detc abnor alleles","description":"Htt (huntingtin) (eg, huntington disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31561","name":"Larynscop remve cart + scop","description":"Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78709","name":"K flow/funct image multiple","description":"Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28039","name":"Exc foot/toe tum sc 1.5 cm/>","description":"Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25900","name":"Amputation of forearm","description":"Amputation, forearm, through radius and ulna;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":598.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58575","name":"Laps tot hyst resj mal","description":"Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77372","name":"Srs linear based","description":"Radiation treatment delivery, stereotactic radiosurgery (srs), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6689","name":"Frame typ socket shoulder di","description":"Upper extremity addition, frame type socket, shoulder disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15833","name":"Exc excessive skin leg","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6009","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"R0070","name":"Transport portable x-ray","description":"Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67911","name":"Revise eyelid defect","description":"Correction of lid retraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69310","name":"Rebuild outer ear canal","description":"Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to injury, infection) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8101","name":"Spacer with mask","description":"Holding chamber or spacer for use with an inhaler or nebulizer; with mask","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33730","name":"Repair heart-vein defect(s)","description":"Complete repair of anomalous pulmonary venous return (supracardiac, intracardiac, or infracardiac types)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2065","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27385","name":"Repair of thigh muscle","description":"Suture of quadriceps or hamstring muscle rupture; primary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55180","name":"Revision of scrotum","description":"Scrotoplasty; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":563.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27151","name":"Incision of hip bones","description":"Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36597","name":"Reposition venous catheter","description":"Repositioning of previously placed central venous catheter under fluoroscopic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33973","name":"Insert balloon device","description":"Insertion of intra-aortic balloon assist device through the ascending aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87003","name":"Small animal inoculation","description":"Animal inoculation, small animal, with observation and dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21172","name":"Rcnst supr-lat orb rm&lw fhd","description":"Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0956","name":"W/c lateral trunk/hip suppor","description":"Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70370","name":"Throat x-ray & fluoroscopy","description":"Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83497","name":"Assay of 5-hiaa","description":"Hydroxyindolacetic acid, 5-(hiaa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45112","name":"Removal of rectum","description":"Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69530","name":"Extensive mastoid surgery","description":"Petrous apicectomy including radical mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1337.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4393","name":"Urine pch w ex wear bar conv","description":"Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8659","name":"Interphalangeal joint repl","description":"Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2750","name":"Plating chrome/nickel pr bar","description":"Addition to lower extremity orthosis, plating chrome or nickel, per bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27446","name":"Revision of knee joint","description":"Arthroplasty, knee, condyle and plateau; medial or lateral compartment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99236","name":"Hosp ip/obs same date hi 85","description":"Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter f","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00851","name":"Anes iper px tubal ligation","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78070","name":"Parathyroid planar imaging","description":"Parathyroid planar imaging (including subtraction, when performed);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28725","name":"Arthrodesis subtalar","description":"Arthrodesis; subtalar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":646.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99349","name":"Home/res vst est mod mdm 40","description":"Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 40 minutes must be met or excee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47140","name":"Partial removal donor liver","description":"Donor hepatectomy (including cold preservation), from living donor; left lateral segment only (segments ii and iii)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51725","name":"Simple cystometrogram","description":"Simple cystometrogram (cmg) (eg, spinal manometer)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95133","name":"Immntx 4 sting insects","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 4 stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2321","name":"Lenticular lens, trifocal","description":"Lenticular lens, per lens, trifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98967","name":"Ph1 assmt&mgmt nqhp 11-20","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78630","name":"Cerebrospinal fluid scan","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2830","name":"Soft interface above knee se","description":"Addition to lower extremity orthosis, soft interface for molded plastic, above knee section","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12045","name":"Intmd rpr n-hf/genit12.6-20","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99358","name":"Prolong service w/o contact","description":"Prolonged evaluation and management service before and/or after direct patient care; first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82960","name":"Test for g6pd enzyme","description":"Glucose-6-phosphate dehydrogenase (g6pd); screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27301","name":"Drain thigh/knee lesion","description":"Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":565.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36835","name":"Insertion thomas shunt","description":"Insertion of thomas shunt (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00811","name":"Anes lwr intst ndsc nos","description":"Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91133","name":"Electrogastrography w/test","description":"Electrogastrography, diagnostic, transcutaneous; with provocative testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23106","name":"Arthrotomy strnclav joint","description":"Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0860","name":"Tract equip cervical tract","description":"Traction equipment, overdoor, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42845","name":"Extensive surgery of throat","description":"Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with other flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1731.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1769","name":"Guide wire","description":"Guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0482","name":"Microprcsr cu combo vad, rep","description":"Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57426","name":"Revise prosth vag graft lap","description":"Revision (including removal) of prosthetic vaginal graft, laparoscopic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73580","name":"Contrast x-ray of knee joint","description":"Radiologic examination, knee, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97760","name":"Orthotic mgmt&traing 1st enc","description":"Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83937","name":"Assay of osteocalcin","description":"Osteocalcin (bone g1a protein)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40840","name":"Reconstruction of mouth","description":"Vestibuloplasty; anterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20606","name":"Drain/inj joint/bursa w/us","description":"Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82248","name":"Bilirubin direct","description":"Bilirubin; direct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15135","name":"Drm agrft f/s/n/h/f/g/m 1st","description":"Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":548.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70555","name":"Fmri brain by phys/psych","description":"Magnetic resonance imaging, brain, functional mri; requiring physician or psychologist administration of entire neurofunctional testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":543.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6714","name":"Ped term dev, hand, vol clos","description":"Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77423","name":"Neutron beam tx complex","description":"High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80168","name":"Assay of ethosuximide","description":"Ethosuximide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32561","name":"Lyse chest fibrin init day","description":"Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); initial day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97036","name":"App mdlty 1+hubbrd tnk ea 15","description":"Application of a modality to 1 or more areas; hubbard tank, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2750","name":"Plating chrome/nickel pr bar","description":"Addition to lower extremity orthosis, plating chrome or nickel, per bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2530","name":"Contact lens gas impermeable","description":"Contact lens, scleral, gas impermeable, per lens (for contact lens modification, see 92325)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60505","name":"Explore parathyroid glands","description":"Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1173.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21462","name":"Optx mndblr fx w/ntrdntl","description":"Open treatment of mandibular fracture; with interdental fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1743.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25145","name":"Remove forearm bone lesion","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":436.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21249","name":"Reconstruction of jaw","description":"Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1117.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34832","name":"Open aortofemor prosth repr","description":"Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82300","name":"Assay of cadmium","description":"Cadmium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3674","name":"So airplane w/wo joint cf","description":"Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0168","name":"Wound closure by adhesive","description":"Wound closure utilizing tissue adhesive(s) only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78835","name":"Rp quan meas single area","description":"Radiopharmaceutical quantification measurement(s) single area (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L5311","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1665.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4080","name":"Repl met band kafo-afo prox","description":"Replace metal bands kafo, proximal thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74425","name":"Urography antegrade rs&i","description":"Urography, antegrade, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62220","name":"Establish brain cavity shunt","description":"Creation of shunt; ventriculo-atrial, -jugular, -auricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46735","name":"Construction of absent anus","description":"Repair of high imperforate anus without fistula; combined transabdominal and sacroperineal approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1901.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69120","name":"Removal of external ear","description":"Excision external ear; complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27580","name":"Fusion of knee","description":"Arthrodesis, knee, any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1234.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2128","name":"Kafo fem fx cast molded to p","description":"Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":962.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25394","name":"Repair carpal bone shorten","description":"Osteoplasty, carpal bone, shortening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":663.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58554","name":"Laparo-vag hyst w/t/o compl","description":"Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":843.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76880","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6388","name":"Postop applicat rigid dsg on","description":"Immediate post surgical or early fitting, application of rigid dressing only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":218.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32906","name":"Revise & repair chest wall","description":"Thoracoplasty, schede type or extrapleural (all stages); with closure of bronchopleural fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35482","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":365.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54161","name":"Circum 28 days or older","description":"Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79101","name":"Nuclear rx iv admin","description":"Radiopharmaceutical therapy, by intravenous administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79101","name":"Nuclear rx iv admin","description":"Radiopharmaceutical therapy, by intravenous administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0516","name":"Insert drug del implant, >=4","description":"Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7013","name":"Disposable compressor filter","description":"Filter, disposable, used with aerosol compressor or ultrasonic generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76981","name":"Use parenchyma","description":"Ultrasound, elastography; parenchyma (eg, organ)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92986","name":"Revision of aortic valve","description":"Percutaneous balloon valvuloplasty; aortic valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1401.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26785","name":"Treat finger dislocation","description":"Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed, single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67105","name":"Repair detached retina pc","description":"Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15576","name":"Pedicle e/n/e/l/ntroral","description":"Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":494.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4236","name":"Silvr oxide batt glucose mon","description":"Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27252","name":"Treat hip dislocation","description":"Closed treatment of hip dislocation, traumatic; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55815","name":"Extensive prostate surgery","description":"Prostatectomy, perineal radical; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1426.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61500","name":"Crnec exc tum/bone les skull","description":"Craniectomy; with excision of tumor or other bone lesion of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0474T","name":"Insj aqueous drg dev io rsvr","description":"Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31395","name":"Reconstruct larynx & pharynx","description":"Pharyngolaryngectomy, with radical neck dissection; with reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61760","name":"Implant brain electrodes","description":"Stereotactic implantation of depth electrodes into the cerebrum for long-term seizure monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1442.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2104","name":"Spherocylindr 4.00d/2.12-4d","description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35637","name":"Bpg aortoiliac","description":"Bypass graft, with other than vein; aortoiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1467.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64484","name":"Njx aa&/strd tfrm epi l/s ea","description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or ct), lumbar or sacral, each additional level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4257","name":"Replace lensshield cartridge","description":"Replacement lens shield cartridge for use with laser skin piercing device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63016","name":"Remove spine lamina >2 thrc","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31715","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20697","name":"App mltpln uni xtrnl fix xch","description":"Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; exchange (ie, removal and replacement) of strut, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33240","name":"Insrt pulse gen w/singl lead","description":"Insertion of implantable defibrillator pulse generator only; with existing single lead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93652","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":791.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01840","name":"Anes art f/arm wrst&hnd nos","description":"Anesthesia for procedures on arteries of forearm, wrist, and hand; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96161","name":"Caregiver health risk assmt","description":"Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83861","name":"Microfluid analy tears","description":"Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95921","name":"Autonomic nrv parasym inervj","description":"Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded r-r interval, valsalva ratio, and 30:15 ratio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48552","name":"Prep donor pancreas/venous","description":"Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61514","name":"Crnec treph exc brn abs sttl","description":"Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess, supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19101","name":"Biopsy of breast open","description":"Biopsy of breast; open, incisional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60220","name":"Partial removal of thyroid","description":"Total thyroid lobectomy, unilateral; with or without isthmusectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":592.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27077","name":"Resect hip tum w/innom bone","description":"Radical resection of tumor; innominate bone, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2404.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64680","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66505","name":"Incision of iris","description":"Iridotomy by stab incision (separate procedure); with transfixion as for iris bombe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44322","name":"Colostomy with biopsies","description":"Colostomy or skin level cecostomy; with multiple biopsies (eg, for congenital megacolon) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":831.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87561","name":"M.avium-intra dna amp prob","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria avium-intracellulare, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33960","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":797.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2500","name":"Thi/glut/ischia wgt bearing","description":"Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63709","name":"Repair spinal fluid leakage","description":"Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84087","name":"Assay phosphohexose enzymes","description":"Phosphohexose isomerase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81286","name":"Fxn gene full gene sequence","description":"Fxn (frataxin) (eg, friedreich ataxia) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0444","name":"Depression screen annual","description":"Annual depression screening, 5 to 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0972","name":"Lso corset front","description":"Lso, corset front","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21825","name":"Treat sternum fracture","description":"Open treatment of sternum fracture with or without skeletal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":463.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78587","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72148","name":"Mri lumbar spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73523","name":"X-ray exam hips bi 5/> views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17314","name":"Mohs addl stage t/a/l","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92961","name":"Cardioversion electric int","description":"Cardioversion, elective, electrical conversion of arrhythmia; internal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81276","name":"Kras gene addl variants","description":"Kras (kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00670","name":"Anes xtnsv sp&spi cord px","description":"Anesthesia for extensive spine and spinal cord procedures (eg, spinal instrumentation or vascular procedures)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27477","name":"Surgery to stop leg growth","description":"Arrest, epiphyseal, any method (eg, epiphysiodesis); tibia and fibula, proximal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27517","name":"Treat thigh fx growth plate","description":"Closed treatment of distal femoral epiphyseal separation; with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73564","name":"X-ray exam knee 4 or more","description":"Radiologic examination, knee; complete, 4 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11980","name":"Implant hormone pellet(s)","description":"Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0779","name":"Amb infusion pump mechanical","description":"Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0237T","name":"Trluml perip athrc brchiocph","description":"Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; brachiocephalic trunk and branches, each vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9507.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44363","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2221","name":"Solid caster tire repl, each","description":"Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6011","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38562","name":"Removal pelvic lymph nodes","description":"Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76885","name":"Us exam infant hips dynamic","description":"Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94729","name":"Diffusing capacity","description":"Diffusing capacity (eg, carbon monoxide, membrane) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2209","name":"Arm trough each","description":"Accessory, arm trough, with or without hand support, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83664","name":"Lamellar bdy fetal lung","description":"Fetal lung maturity assessment; lamellar body density","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26770","name":"Treat finger dislocation","description":"Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90966","name":"Esrd home pt serv p mo 20+","description":"End-stage renal disease (esrd) related services for home dialysis per full month, for patients 20 years of age and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66700","name":"Destruction ciliary body","description":"Ciliary body destruction; diathermy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85014","name":"Hematocrit","description":"Blood count; hematocrit (hct)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41000","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49655","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":862.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88106","name":"Cytopath fl nongyn filter","description":"Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87176","name":"Tissue homogenization cultr","description":"Homogenization, tissue, for culture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87531","name":"Hhv-6 dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); herpes virus-6, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84305","name":"Assay of somatomedin","description":"Somatomedin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4428","name":"Urine ost pouch w faucet/tap","description":"Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35112","name":"Repair artery rupture spleen","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, splenic artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1444.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86688","name":"Htlv-ii antibody","description":"Antibody; htlv-ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33770","name":"Rpr tga w/o surg enlgmnt vsd","description":"Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; without surgical enlargement of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1845.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99396","name":"Prev visit est age 40-64","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42860","name":"Excision of tonsil tags","description":"Excision of tonsil tags","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47510","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91055","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4611","name":"Heavy duty battery","description":"Battery, heavy duty; replacement for patient owned ventilator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4250","name":"Urine reagent strips/tablets","description":"Urine test or reagent strips or tablets (100 tablets or strips)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76380","name":"Cat scan follow-up study","description":"Computed tomography, limited or localized follow-up study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23077","name":"Rad rescj tum shoulder<5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":975.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96002","name":"Dynamic surface emg","description":"Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49653","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":775.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6204","name":"Composite drsg >16<=48 sq in","description":"Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5655","name":"Socket insert below knee","description":"Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27828","name":"Treat lower leg fracture","description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27415","name":"Osteochondral knee allograft","description":"Osteochondral allograft, knee, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50770","name":"Splicing of ureters","description":"Transureteroureterostomy, anastomosis of ureter to contralateral ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":933.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0269","name":"Occlusive device in vein art","description":"Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6670","name":"Hook to hand cable adapter","description":"Upper extremity addition, hook to hand, cable adapter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31755","name":"Trachplsty trchphryngl fstlj","description":"Tracheoplasty; tracheopharyngeal fistulization, each stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1290.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11622","name":"Exc s/n/h/f/g mal+mrg 1.1-2","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67345","name":"Destroy nerve of eye muscle","description":"Chemodenervation of extraocular muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0452","name":"Molecular pathology interpr","description":"Molecular pathology procedure; physician interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93282","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82810","name":"Blood gases o2 sat only","description":"Gases, blood, o2 saturation only, by direct measurement, except pulse oximetry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83970","name":"Assay of parathormone","description":"Parathormone (parathyroid hormone)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95017","name":"All tstg perq&iq w/venoms","description":"Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6707","name":"Term dev mech hook vol close","description":"Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28315","name":"Removal of sesamoid bone","description":"Sesamoidectomy, first toe (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33272","name":"Rmvl of subq defibrillator","description":"Removal of subcutaneous implantable defibrillator electrode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22634","name":"Arthrd cmbn 1ntrspc ea addl","description":"Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (list separately in addition to code for prima","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25365","name":"Revise radius & ulna","description":"Osteotomy; radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":774.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45114","name":"Partial removal of rectum","description":"Proctectomy, partial, with anastomosis; abdominal and transsacral approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78582","name":"Lung ventilat&perfus imaging","description":"Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61697","name":"Brain aneurysm repr complx","description":"Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3926.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65210","name":"Remove foreign body from eye","description":"Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6680","name":"Test sock wrist disart/bel e","description":"Upper extremity addition, test socket, wrist disarticulation or below elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75840","name":"Vein x-ray adrenal gland","description":"Venography, adrenal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1720","name":"Legg perthes orthosis trilat","description":"Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":614.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2136","name":"Kafo femoral fx cast rigid","description":"Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67320","name":"Revise eye muscle(s) add-on","description":"Transposition procedure (eg, for paretic extraocular muscle), any extraocular muscle (specify) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":191.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49326","name":"Lap w/omentopexy add-on","description":"Laparoscopy, surgical; with omentopexy (omental tacking procedure) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44312","name":"Revision of ileostomy","description":"Revision of ileostomy; simple (release of superficial scar) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":481.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00864","name":"Anes xtrprt lwr abd tot cstc","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; total cystectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63275","name":"Bx/exc xdrl spine lesn crvl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1638.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21194","name":"Reconst lwr jaw w/graft","description":"Reconstruction of mandibular rami, horizontal, vertical, c, or l osteotomy; with bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1144.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84165","name":"Protein e-phoresis serum","description":"Protein; electrophoretic fractionation and quantitation, serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19287","name":"Perq dev breast 1st mr guide","description":"Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":481.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66852","name":"Removal of lens material","description":"Removal of lens material; pars plana approach, with or without vitrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34451","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by abdominal and leg incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":780.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26118","name":"Rad resect hand tumor 3 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27248","name":"Treat thigh fracture","description":"Open treatment of greater trochanteric fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":631.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90961","name":"Esrd srv 2-3 vsts p mo 20+","description":"End-stage renal disease (esrd) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6010","name":"Collagen based wound filler","description":"Collagen based wound filler, dry form, sterile, per gram of collagen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2050","name":"Hkafo torsion cable hip pelv","description":"Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36568","name":"Insj picc <5 yr w/o imaging","description":"Insertion of peripherally inserted central venous catheter (picc), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93567","name":"Njx car cth sprvlv aortgrphy","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5500","name":"Init bk ptb plaster direct","description":"Initial, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":637.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86860","name":"Rbc antibody elution","description":"Antibody elution (rbc), each elution","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25025","name":"Decompress forearm 2 spaces","description":"Decompression fasciotomy, forearm and/or wrist, flexor and extensor compartment; with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1016.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28060","name":"Partial removal foot fascia","description":"Fasciectomy, plantar fascia; partial (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11046","name":"Dbrdmt musc&/fsca ea addl","description":"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77048","name":"Mri breast c-+ w/cad uni","description":"Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (cad real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99341","name":"Home/res vst new sf mdm 15","description":"Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0473T","name":"Reprgrmg io rta eltrd ra","description":"Device evaluation and interrogation of intraocular retinal electrode array (eg, retinal prosthesis), in person, including reprogramming and visual training, when performed, with review and report by a qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33694","name":"Cmp rpr tof wo plm atrs ptch","description":"Complete repair tetralogy of fallot without pulmonary atresia; with transannular patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87328","name":"Cryptosporidium ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; cryptosporidium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50783","name":"Reimplant ureter in bladder","description":"Ureteroneocystostomy; with extensive ureteral tailoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23170","name":"Sequestrectomy clavicle","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":472.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2369","name":"Pwr wc drivewheel gear repl","description":"Power wheelchair component, drive wheel gear box, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49062","name":"Drain to peritoneal cavity","description":"Drainage of extraperitoneal lymphocele to peritoneal cavity, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42961","name":"Control throat bleeding","description":"Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); complicated, requiring hospitalization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99334","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38221","name":"Dx bone marrow biopsies","description":"Diagnostic bone marrow; biopsy(ies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4102","name":"Ef adult fluids and electro","description":"Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72202","name":"X-ray exam si joints 3/> vws","description":"Radiologic examination, sacroiliac joints; 3 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53510","name":"Repair of urethra injury","description":"Urethrorrhaphy, suture of urethral wound or injury; perineal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":510.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54406","name":"Remove muti-comp penis pros","description":"Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6882","name":"Microprocessor control uplmb","description":"Microprocessor control feature, addition to upper limb prosthetic terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1510.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5220","name":"No knee joint with artic ali","description":"Above knee, short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1465.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0900","name":"Trac stand free stand pelvic","description":"Traction stand, free standing, pelvic traction, (e.g., bucks)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51050","name":"Removal of bladder stone","description":"Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50382","name":"Change ureter stent percut","description":"Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88188","name":"Flowcytometry/read 9-15","description":"Flow cytometry, interpretation; 9 to 15 markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28118","name":"Removal of heel bone","description":"Ostectomy, calcaneus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0155","name":"Walker wheel attachment,pair","description":"Wheel attachment, rigid pick-up walker, per pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72270","name":"Myelogphy 2/> spine regions","description":"Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6017","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94772","name":"Circadian respir pattern rec","description":"Circadian respiratory pattern recording (pediatric pneumogram), 12-24 hour continuous recording, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1860","name":"Ko supracondylar socket mold","description":"Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":609.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0982","name":"Back upholstery, replacement","description":"Wheelchair accessory, back upholstery, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75891","name":"Vein x-ray liver","description":"Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86787","name":"Varicella-zoster antibody","description":"Antibody; varicella-zoster","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62116","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1386.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4360","name":"Pneumat walking boot pre cst","description":"Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81188","name":"Cstb gene detc abnor allele","description":"Cstb (cystatin b) (eg, unverricht-lundborg disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82488","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13132","name":"Cmplx rpr f/c/c/m/n/ax/g/h/f","description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":294.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85397","name":"Clotting funct activity","description":"Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, adamts-13), each analyte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11300","name":"Shave skin lesion 0.5 cm/<","description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61320","name":"Crnec/crnot drg icr abs sttl","description":"Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72193","name":"Ct pelvis w/dye","description":"Computed tomography, pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74021","name":"Radex abdomen 3+ views","description":"Radiologic examination, abdomen; 3 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21555","name":"Exc neck les sc < 3 cm","description":"Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0560","name":"Humidifier supplemental w/ i","description":"Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85306","name":"Clot inhibit prot s free","description":"Clotting inhibitors or anticoagulants; protein s, free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27822","name":"Treatment of ankle fracture","description":"Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":725.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34001","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":806.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27780","name":"Treatment of fibula fracture","description":"Closed treatment of proximal fibula or shaft fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61635","name":"Intracran angioplsty w/stent","description":"Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7524","name":"Tracheostoma stent/stud/bttn","description":"Tracheostoma stent/stud/button, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92582","name":"Conditioning play audiometry","description":"Conditioning play audiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49082","name":"Abd paracentesis","description":"Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57465","name":"Cam cervix uteri drg colp","description":"Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19294","name":"Prepj tum cav iort prtl mast","description":"Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (iort) concurrent with partial mastectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62324","name":"Njx interlaminar crv/thrc","description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thorac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96156","name":"Hlth bhv assmt/reassessment","description":"Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67430","name":"Explore/treat eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":795.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0994","name":"Wheelchair arm rest","description":"Arm rest, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2112","name":"Spherocylindr 7.25d/2.25-4d","description":"Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2201","name":"Lens sphere bifocal 4.12-7.0","description":"Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95873","name":"Guide nerv destr elec stim","description":"Electrical stimulation for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36145","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31560","name":"Laryngoscop w/arytenoidectom","description":"Laryngoscopy, direct, operative, with arytenoidectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50040","name":"Nfros nfrot w/drg","description":"Nephrostomy, nephrotomy with drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61711","name":"Fusion of skull arteries","description":"Anastomosis, arterial, extracranial-intracranial (eg, middle cerebral/cortical) arteries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2373.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72170","name":"X-ray exam of pelvis","description":"Radiologic examination, pelvis; 1 or 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27884","name":"Amputation follow-up surgery","description":"Amputation, leg, through tibia and fibula; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95861","name":"Needle emg 2 extremities","description":"Needle electromyography; 2 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19361","name":"Brst rcnstj latsms drsi flap","description":"Breast reconstruction; with latissimus dorsi flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1015.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43336","name":"Thorabd diaphr hern repair","description":"Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8513","name":"Trach pros cleaning device","description":"Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78232","name":"Salivary gland function std","description":"Salivary gland function study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82108","name":"Assay of aluminum","description":"Aluminum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88188","name":"Flowcytometry/read 9-15","description":"Flow cytometry, interpretation; 9 to 15 markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35665","name":"Bpg iliofemoral","description":"Bypass graft, with other than vein; iliofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1033.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44207","name":"L colectomy/coloproctostomy","description":"Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1476.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33427","name":"Repair of mitral valve","description":"Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88150","name":"Cytopath c/v manual","description":"Cytopathology, slides, cervical or vaginal; manual screening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63056","name":"Decompress spinal cord lmbr","description":"Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58940","name":"Removal of ovary(s)","description":"Oophorectomy, partial or total, unilateral or bilateral;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33852","name":"Rpr hypopl a-arch wo byp","description":"Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1213.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64530","name":"N block inj celiac pelus","description":"Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27200","name":"Treat tail bone fracture","description":"Closed treatment of coccygeal fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72220","name":"X-ray exam sacrum tailbone","description":"Radiologic examination, sacrum and coccyx, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69802","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":782.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93591","name":"Perq transcath cls aortic","description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":864.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19284","name":"Perq dev breast add strtctc","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93619","name":"Comprehensive ep evaluation","description":"Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, his bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93270","name":"Remote 30 day ecg rev/report","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42305","name":"Drainage of salivary gland","description":"Drainage of abscess; parotid, complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2502","name":"Contact lens pmma bifocal","description":"Contact lens, pmma, bifocal, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33226","name":"Reposition l ventric lead","description":"Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4542","name":"Small disposable underpad","description":"Incontinence product, disposable underpad, small size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26045","name":"Release palm contracture","description":"Fasciotomy, palmar (eg, dupuytrens contracture); open, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65265","name":"Remove foreign body from eye","description":"Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":655.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46221","name":"Ligation of hemorrhoid(s)","description":"Hemorrhoidectomy, internal, by rubber band ligation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00926","name":"Anes male gent rad orch ing","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); radical orchiectomy, inguinal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0821","name":"Pwc gp 2 std port cap chair","description":"Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00702","name":"Anes upr ant abd wall lvr bx","description":"Anesthesia for procedures on upper anterior abdominal wall; percutaneous liver biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45398","name":"Colonoscopy w/band ligation","description":"Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":608.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0459","name":"Telehealth inpt pharm mgmt","description":"Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19120","name":"Removal of breast lesion","description":"Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":330.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33764","name":"Shunt central w/prostc graft","description":"Shunt; central, with prosthetic graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75831","name":"Vein x-ray kidney","description":"Venography, renal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74355","name":"X-ray guide intestinal tube","description":"Percutaneous placement of enteroclysis tube, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7016","name":"Nebulizer dome & mouthpiece","description":"Dome and mouthpiece, used with small volume ultrasonic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26160","name":"Remove tendon sheath lesion","description":"Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87281","name":"Pneumocystis carinii ag if","description":"Infectious agent antigen detection by immunofluorescent technique; pneumocystis carinii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0153","name":"Forearm crutch platform atta","description":"Platform attachment, forearm crutch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33692","name":"Comp rpr tof wo pulm atresia","description":"Complete repair tetralogy of fallot without pulmonary atresia;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1704.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75870","name":"Vein x-ray skull","description":"Venography, superior sagittal sinus, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94621","name":"Cardiopulm exercise testing","description":"Cardiopulmonary exercise testing, including measurements of minute ventilation, co2 production, o2 uptake, and electrocardiographic recordings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51900","name":"Repair bladder/vagina lesion","description":"Closure of vesicovaginal fistula, abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":667.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4416","name":"Ost pch clsd w barrier/filtr","description":"Ostomy pouch, closed, with barrier attached, with filter (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4523","name":"Adult size brief/diaper lg","description":"Adult sized disposable incontinence product, brief/diaper, large, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0074A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90880","name":"Hypnotherapy","description":"Hypnotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26497","name":"Finger tendon transfer","description":"Transfer of tendon to restore intrinsic function; ring and small finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":735.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6709","name":"Term dev mech hand vol close","description":"Terminal device, hand, mechanical, voluntary closing, any material, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":610.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54560","name":"Exploration for testis","description":"Exploration for undescended testis with abdominal exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59425","name":"Antepartum care only","description":"Antepartum care only; 4-6 visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97763","name":"Orthc/prostc mgmt sbsq enc","description":"Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49424","name":"Assess cyst contrast inject","description":"Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88273","name":"Cytogenetics 10-30","description":"Molecular cytogenetics; chromosomal in situ hybridization, analyze 10-30 cells (eg, for microdeletions)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95907","name":"Nvr cndj tst 1-2 studies","description":"Nerve conduction studies; 1-2 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42892","name":"Revision of pharyngeal walls","description":"Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior pharyngeal walls","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1452.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11057","name":"Parng/cutg b9 hyprkr les >4","description":"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than 4 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1050","name":"Whelchr fxd full length arms","description":"Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50605","name":"Insert ureteral support","description":"Ureterotomy for insertion of indwelling stent, all types","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":852.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32488","name":"Completion pneumonectomy","description":"Removal of lung, other than pneumonectomy; with all remaining lung following previous removal of a portion of lung (completion pneumonectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76970","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6611","name":"Additional switch, ext power","description":"Addition to upper extremity prosthesis, external powered, additional switch, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88189","name":"Flowcytometry/read 16 & >","description":"Flow cytometry, interpretation; 16 or more markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33227","name":"Remove&replace pm gen singl","description":"Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84252","name":"Assay of vitamin b-2","description":"Riboflavin (vitamin b-2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4426","name":"Ost pch drain 2 piece system","description":"Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21451","name":"Cltx mndblr fx w/mnpj","description":"Closed treatment of mandibular fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":604.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75733","name":"Artery x-rays adrenals","description":"Angiography, adrenal, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27071","name":"Part removal hip bone deep","description":"Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":797.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95981","name":"Io anal gast n-stim subsq","description":"Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2604","name":"Skin protect wc cus wd>=22in","description":"Skin protection wheelchair seat cushion, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96921","name":"Excimer lsr psriasis 250-500","description":"Excimer laser treatment for psoriasis; 250 sq cm to 500 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61760","name":"Implant brain electrodes","description":"Stereotactic implantation of depth electrodes into the cerebrum for long-term seizure monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6582","name":"Wrist/elbow bowden cbl dir f","description":"Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65400","name":"Removal of eye lesion","description":"Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":414.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6689","name":"Frame typ socket shoulder di","description":"Upper extremity addition, frame type socket, shoulder disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43265","name":"Ercp lithotripsy calculi","description":"Endoscopic retrograde cholangiopancreatography (ercp); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82485","name":"Assay chondroitin sulfate","description":"Chondroitin b sulfate, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84157","name":"Assay of protein other","description":"Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23406","name":"Incise tendon(s) & muscle(s)","description":"Tenotomy, shoulder area; multiple tendons through same incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":644.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86805","name":"Lymphocytotoxicity assay","description":"Lymphocytotoxicity assay, visual crossmatch; with titration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0271","name":"Group mnt 2 or more 30 mins","description":"Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26844","name":"Fusion/graft of hand joint","description":"Arthrodesis, carpometacarpal joint, digit, other than thumb, each; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":697.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73040","name":"Contrast x-ray of shoulder","description":"Radiologic examination, shoulder, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1110","name":"Ring flange plas/leather mol","description":"Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28208","name":"Repair of foot tendon","description":"Repair, tendon, extensor, foot; primary or secondary, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99221","name":"1st hosp ip/obs sf/low 40","description":"Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. when using total time on the date of the encounter for code selection, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65175","name":"Removal of ocular implant","description":"Removal of ocular implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7503","name":"Hmes filter holder or cap","description":"Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26567","name":"Correct finger deformity","description":"Osteotomy; phalanx of finger, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34401","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; vena cava, iliac vein, by abdominal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":773.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7501","name":"Tracheostoma valve w diaphra","description":"Tracheostoma valve, including diaphragm, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82728","name":"Assay of ferritin","description":"Ferritin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82651","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76978","name":"Us trgt dyn mbubb 1st les","description":"Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85307","name":"Assay activated protein c","description":"Activated protein c (apc) resistance assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26480","name":"Transplant hand tendon","description":"Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85270","name":"Clot factor xi pta","description":"Clotting; factor xi (pta)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9490","name":"Cmmi mod home visit","description":"Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/man","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78429","name":"Myocrd img pet 1 std w/ct","description":"Myocardial imaging, positron emission tomography (pet), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study; with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88365","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92274","name":"Multifocal erg w/i&r","description":"Electroretinography (erg), with interpretation and report; multifocal (mferg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8410","name":"Sheath above knee","description":"Prosthetic sheath, above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87538","name":"Hiv-2 probe&revrse trnscripj","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-2, amplified probe technique, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25449","name":"Revj arthrp wrist joint","description":"Revision of arthroplasty, including removal of implant, wrist joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85247","name":"Clot factor viii multimetric","description":"Clotting; factor viii, von willebrand factor, multimetric analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1225","name":"Manual semi-reclining back","description":"Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61800","name":"Apply srs headframe add-on","description":"Application of stereotactic headframe for stereotactic radiosurgery (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5811","name":"Endo knee-shin mnl lck ultra","description":"Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S0610","name":"Annual gynecological examina","description":"Annual gynecological examination, new patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21060","name":"Remove jaw joint cartilage","description":"Meniscectomy, partial or complete, temporomandibular joint (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":637.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72191","name":"Ct angiograph pelv w/o&w/dye","description":"Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62321","name":"Njx interlaminar crv/thrc","description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36245","name":"Ins cath abd/l-ext art 1st","description":"Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27265","name":"Treat hip dislocation","description":"Closed treatment of post hip arthroplasty dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0402","name":"Initial preventive exam","description":"Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00541","name":"Anes thrcm px 1 lung vntj","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81285","name":"Fxn gene charac alleles","description":"Fxn (frataxin) (eg, friedreich ataxia) gene analysis; characterization of alleles (eg, expanded size)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33676","name":"Close mult vsd w/resection","description":"Closure of multiple ventricular septal defects; with pulmonary valvotomy or infundibular resection (acyanotic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15152","name":"Tis cltr skn agrft t/a/l ea","description":"Tissue cultured skin autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43249","name":"Esoph egd dilation <30 mm","description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":841.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95863","name":"Needle emg 3 extremities","description":"Needle electromyography; 3 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95071","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97166","name":"Ot eval mod complex 45 min","description":"Occupational therapy evaluation, moderate complexity, requiring these components: an occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current func","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49425","name":"Insert abdomen-venous drain","description":"Insertion of peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54680","name":"Relocation of testis(es)","description":"Transplantation of testis(es) to thigh (because of scrotal destruction)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":637.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5985","name":"Lwr ext dynamic prosth pylon","description":"All endoskeletal lower extremity prostheses, dynamic prosthetic pylon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50830","name":"Revise urine flow","description":"Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81025","name":"Urine pregnancy test","description":"Urine pregnancy test, by visual color comparison methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66179","name":"Aqueous shunt eye w/o graft","description":"Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":648.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49322","name":"Laparoscopy aspiration","description":"Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62350","name":"Implant spinal canal cath","description":"Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50976","name":"Ureter endoscopy & treatment","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91038","name":"Esoph imped funct test > 1hr","description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to 24 hours)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0216T","name":"Njx paravert w/us lumb/sac","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34808","name":"Endovas iliac a device addon","description":"Endovascular placement of iliac artery occlusion device (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64462","name":"Pvb thoracic 2nd+ inj site","description":"Paravertebral block (pvb) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35221","name":"Rpr bld vsl dir intra-abdl","description":"Repair blood vessel, direct; intra-abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2309","name":"Lens sphc trifocal 4.25-7/4.","description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57555","name":"Remove cervix/repair vagina","description":"Excision of cervical stump, vaginal approach; with anterior and/or posterior repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93284","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous impla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6670","name":"Hook to hand cable adapter","description":"Upper extremity addition, hook to hand, cable adapter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86615","name":"Bordetella antibody","description":"Antibody; bordetella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31631","name":"Bronchoscopy dilate w/stent","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95147","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 3 single stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10180","name":"I&d complex po wound infctj","description":"Incision and drainage, complex, postoperative wound infection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01380","name":"Anes all clsd px knee joint","description":"Anesthesia for all closed procedures on knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2221","name":"Lenticular lens, bifocal","description":"Lenticular lens, per lens, bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73225","name":"Mr angio upr extr w/o&w/dye","description":"Magnetic resonance angiography, upper extremity, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78351","name":"Bone mineral dual photon","description":"Bone density (bone mineral content) study, 1 or more sites; dual photon absorptiometry, 1 or more sites","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53620","name":"Dilate urethra stricture","description":"Dilation of urethral stricture by passage of filiform and follower, male; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80055","name":"Obstetric panel","description":"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 (85007 or 85009) hepatitis b surface antigen (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6000","name":"Part hand thumb rem","description":"Partial hand, thumb remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64581","name":"Opn impltj nea sacral nerve","description":"Open implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22527","name":"Idet 1 or more levels","description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88386","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":419.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36226","name":"Place cath vertebral art","description":"Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1604.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0309","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":335.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5114","name":"Foam/fabric leg strap","description":"Leg strap; foam or fabric, replacement only, per set","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76145","name":"Med physic dos eval rad exps","description":"Medical physics dose evaluation for radiation exposure that exceeds institutional review threshold, including report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77261","name":"Ther radiology tx plng smpl","description":"Therapeutic radiology treatment planning; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75658","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44625","name":"Repair bowel opening","description":"Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67220","name":"Treatment of choroid lesion","description":"Destruction of localized lesion of choroid (eg, choroidal neovascularization); photocoagulation (eg, laser), 1 or more sessions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":514.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61640","name":"Dilate ic vasospasm init","description":"Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0002","name":"Stnd hemi (low seat) whlchr","description":"Standard hemi (low seat) wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95866","name":"Needle emg hemidiaphragm","description":"Needle electromyography; hemidiaphragm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81596","name":"Nfct ds chrnc hcv 6 assays","description":"Infectious disease, chronic hepatitis c virus (hcv) infection, six biochemical assays (alt, a2-macroglobulin, apolipoprotein a-1, total bilirubin, ggt, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86430","name":"Rheumatoid factor test qual","description":"Rheumatoid factor; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27418","name":"Repair degenerated kneecap","description":"Anterior tibial tubercleplasty (eg, maquet type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":697.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95976","name":"Alys smpl cn npgt prgrmg","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83519","name":"Ria nonantibody","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, ria)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15847","name":"Exc skin abd add-on","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22210","name":"Incis 1 vertebral seg cerv","description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1583.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0605","name":"Repl batt lithium 4.5 v","description":"Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49590","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":476.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50630","name":"Removal of ureter stone","description":"Ureterolithotomy; lower one-third of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":722.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5920","name":"Endo ak/hip alignable system","description":"Addition, endoskeletal system, above knee or hip disarticulation, alignable system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1821","name":"Replacement interface spsd","description":"Replacement soft interface material/cuffs for bi-directional static progressive stretch device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00147","name":"Anes px on eye iridectomy","description":"Anesthesia for procedures on eye; iridectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41019","name":"Place needles h&n for rt","description":"Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6411","name":"Non-sterile eye pad","description":"Eye pad, non-sterile, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86885","name":"Coombs test indirect qual","description":"Antihuman globulin test (coombs test); indirect, qualitative, each reagent red cell","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38240","name":"Transplt allo hct/donor","description":"Hematopoietic progenitor cell (hpc); allogeneic transplantation per donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77066","name":"Dx mammo incl cad bi","description":"Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81237","name":"Ezh2 gene common variants","description":"Ezh2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, diffuse large b-cell lymphoma) gene analysis, common variant(s) (eg, codon 646)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46260","name":"Remove in/ex hem groups 2+","description":"Hemorrhoidectomy, internal and external, 2 or more columns/groups;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":385.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86885","name":"Coombs test indirect qual","description":"Antihuman globulin test (coombs test); indirect, qualitative, each reagent red cell","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44620","name":"Repair bowel opening","description":"Closure of enterostomy, large or small intestine;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":710.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51530","name":"Removal of bladder lesion","description":"Cystotomy; for excision of bladder tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":623.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2222","name":"Solid caster integ whl, repl","description":"Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5855","name":"Mech hip extension assist","description":"Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0298T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94728","name":"Airwy resist by oscillometry","description":"Airway resistance by oscillometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11626","name":"Exc s/n/h/f/g mal+mrg >4 cm","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":257.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86732","name":"Mucormycosis antibody","description":"Antibody; mucormycosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11107","name":"Incal bx skn ea sep/addl","description":"Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57265","name":"Cmbn ap colprhy w/ntrcl rpr","description":"Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed; with enterocele repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23473","name":"Revis reconst shoulder joint","description":"Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1370.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29884","name":"Arthrs knee surg lysis ads","description":"Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77785","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3540","name":"Ortho shoe add full sole","description":"Orthopedic shoe addition, sole, full","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22513","name":"Perq vertebral augmentation","description":"Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5394.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22600","name":"Arthrd pst tq 1ntrspc crv","description":"Arthrodesis, posterior or posterolateral technique, single interspace; cervical below c2 segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57426","name":"Revise prosth vag graft lap","description":"Revision (including removal) of prosthetic vaginal graft, laparoscopic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0572","name":"Aerosol compressor adjust pr","description":"Aerosol compressor, adjustable pressure, light duty for intermittent use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51703","name":"Insert bladder cath complex","description":"Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4361","name":"Ostomy face plate","description":"Ostomy faceplate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23030","name":"I&d shoulder deep absc/hmtma","description":"Incision and drainage, shoulder area; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0148","name":"Heavyduty walker no wheels","description":"Walker, heavy duty, without wheels, rigid or folding, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36470","name":"Njx sclrsnt 1 incmptnt vein","description":"Injection of sclerosant; single incompetent vein (other than telangiectasia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4352","name":"Coude tip urinary catheter","description":"Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68530","name":"Clearance of tear duct","description":"Removal of foreign body or dacryolith, lacrimal passages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81285","name":"Fxn gene charac alleles","description":"Fxn (frataxin) (eg, friedreich ataxia) gene analysis; characterization of alleles (eg, expanded size)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33944","name":"Prepare donor heart","description":"Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21601","name":"Exc chest wall tumor w/ribs","description":"Excision of chest wall tumor including rib(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1020.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95718","name":"Eeg phys/qhp 2-12 hr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report, 2-12 hours of eeg recording; with video (veeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88388","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99221","name":"1st hosp ip/obs sf/low 40","description":"Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. when using total time on the date of the encounter for code selection, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8902","name":"Mra w/o fol w/cont, abd","description":"Magnetic resonance angiography without contrast followed by with contrast, abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99232","name":"Sbsq hosp ip/obs moderate 35","description":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 35 minut","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6224","name":"Gauze > 48 in no w/sal w/o b","description":"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43201","name":"Esoph scope w/submucous inj","description":"Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":187.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76975","name":"Gi endoscopic ultrasound","description":"Gastrointestinal endoscopic ultrasound, supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92997","name":"Pul art balloon repr percut","description":"Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87075","name":"Cultr bacteria except blood","description":"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35303","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; popliteal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35500","name":"Harvest vein for bypass","description":"Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87640","name":"Staph a dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); staphylococcus aureus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6623","name":"Spring-ass rot wrst w/ latch","description":"Upper extremity addition, spring assisted rotational wrist unit with latch release","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":318.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71101","name":"X-ray exam unilat ribs/chest","description":"Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88319","name":"Enzyme histochemistry","description":"Special stain including interpretation and report; group iii, for enzyme constituents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1300","name":"Body jacket mold to patient","description":"Other scoliosis procedure, body jacket molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1037.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29131","name":"Appl finger splint dynamic","description":"Application of finger splint; dynamic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98972","name":"Nqhp ol dig assmt&mgmt 21+","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59425","name":"Antepartum care only","description":"Antepartum care only; 4-6 visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1230","name":"Milwaukee type superstructur","description":"Addition to tlso, (low profile), milwaukee type superstructure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0785","name":"Replacement impl pump cathet","description":"Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0103","name":"Psa screening","description":"Prostate cancer screening; prostate specific antigen test (psa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4534","name":"Youth size pull-on","description":"Youth sized disposable incontinence product, protective underwear/pull-on, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24587","name":"Optx partclr fx&/dslc elbw w","description":"Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius); with implant arthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51580","name":"Remove bladder/revise tract","description":"Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47721","name":"Fuse upper gi structures","description":"Cholecystoenterostomy; with gastroenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1135.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40720","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":824.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33270","name":"Ins/rep subq defibrillator","description":"Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic param","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":488.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28490","name":"Treat big toe fracture","description":"Closed treatment of fracture great toe, phalanx or phalanges; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33523","name":"Cabg art-vein six or more","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":727.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4529","name":"Ped size brief/diaper sm/med","description":"Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35671","name":"Bpg pop-tibl/-prnl artery","description":"Bypass graft, with other than vein; popliteal-tibial or -peroneal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":987.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41016","name":"Drainage of mouth lesion","description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submental","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":349.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12042","name":"Intmd rpr n-hf/genit2.6-7.5","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5718","name":"Knee-shin exo frct swg & sta","description":"Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":452.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69641","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6254","name":"Absorpt drg <=16 sq in w/bdr","description":"Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0117","name":"Underarm springassist crutch","description":"Crutch, underarm, articulating, spring assisted, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62290","name":"Njx px discography lumbar","description":"Injection procedure for discography, each level; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66710","name":"Ciliary transsleral therapy","description":"Ciliary body destruction; cyclophotocoagulation, transscleral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32815","name":"Close bronchial fistula","description":"Open closure of major bronchial fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83150","name":"Assay of homovanillic acid","description":"Homovanillic acid (hva)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78453","name":"Ht muscle image planar sing","description":"Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44388","name":"Colonoscopy thru stoma spx","description":"Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","53",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67914","name":"Repair eyelid defect","description":"Repair of ectropion; suture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65880","name":"Incise inner eye adhesions","description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); corneovitreal adhesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86343","name":"Leukocyte histamine release","description":"Leukocyte histamine release test (lhr)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4245","name":"Alcohol wipes per box","description":"Alcohol wipes, per box","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51729","name":"Cystometrogram w/vp&up","description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43648","name":"Lap revise/remv eltrd antrum","description":"Laparoscopy, surgical; revision or removal of gastric neurostimulator electrodes, antrum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65420","name":"Removal of eye lesion","description":"Excision or transposition of pterygium; without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95939","name":"C motor evoked upr&lwr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43202","name":"Esophagoscopy flex biopsy","description":"Esophagoscopy, flexible, transoral; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":261.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2623","name":"Plastic eye prosth custom","description":"Prosthetic eye, plastic, custom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":575.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0166","name":"Extrnl counterpulse, per tx","description":"External counterpulsation, per treatment session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92314","name":"C-lens fitg tech ou","description":"Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens, both eyes except for aphakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4379","name":"Urinary plastic pouch w fcpl","description":"Ostomy pouch, urinary, with faceplate attached, plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43206","name":"Esoph optical endomicroscopy","description":"Esophagoscopy, flexible, transoral; with optical endomicroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":219.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76815","name":"Ob us limited fetus(s)","description":"Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90840","name":"Psytx crisis ea addl 30 min","description":"Psychotherapy for crisis; each additional 30 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57330","name":"Repair bladder-vagina lesion","description":"Closure of vesicovaginal fistula; transvesical and vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87140","name":"Culture type immunofluoresc","description":"Culture, typing; immunofluorescent method, each antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27502","name":"Treatment of thigh fracture","description":"Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38200","name":"Injection for spleen x-ray","description":"Injection procedure for splenoportography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63017","name":"Remove spine lamina >2 lmbr","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33572","name":"Open coronary endarterectomy","description":"Coronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery performed in conjunction with coronary artery bypass graft procedure, each vessel (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58140","name":"Myomectomy abdom method","description":"Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25515","name":"Optx radial shaft fracture","description":"Open treatment of radial shaft fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93289","name":"Interrog device eval heart","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including anal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97597","name":"Dbrdmt opn wnd 1st 20 cm/<","description":"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when perform","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82607","name":"Vitamin b-12","description":"Cyanocobalamin (vitamin b-12);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64643","name":"Chemodenerv 1 extrem 1-4 ea","description":"Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78593","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15430","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":388.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23065","name":"Biopsy shoulder tissues","description":"Biopsy, soft tissue of shoulder area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55540","name":"Revise hernia & sperm veins","description":"Excision of varicocele or ligation of spermatic veins for varicocele; with hernia repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3219","name":"Orthopedic mens shoes oxford","description":"Orthopedic footwear, mens shoe, oxford, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0455","name":"Fecal microbiota prep instil","description":"Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0782","name":"Non-programble infusion pump","description":"Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82252","name":"Fecal bilirubin test","description":"Bilirubin; feces, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45171","name":"Exc rect tum transanal part","description":"Excision of rectal tumor, transanal approach; not including muscularis propria (ie, partial thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":485.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25446","name":"Arthrp w/prostc dst rds&crps","description":"Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":984.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01756","name":"Anes opn/arthrs elbw rad px","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; radical procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33989","name":"Removal of left heart vent","description":"Removal of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ecmo/ecls","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0313","name":"Immunize couns < 21yr 6-30 m","description":"Immunization counseling by a physician or other qualified health care professional when  the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time (this code is used for medicaid billing purposes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86510","name":"Histoplasmosis skin test","description":"Skin test; histoplasmosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92521","name":"Evaluation of speech fluency","description":"Evaluation of speech fluency (eg, stuttering, cluttering)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83655","name":"Assay of lead","description":"Lead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42320","name":"Drainage of salivary gland","description":"Drainage of abscess; submaxillary, external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2102","name":"Singl visn sphere 7.12-20.00","description":"Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24430","name":"Rpr non/mal humerus wo graft","description":"Repair of nonunion or malunion, humerus; without graft (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":891.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0602","name":"Repl batt silver oxide 3 v","description":"Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64623","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50920","name":"Closure ureter/skin fistula","description":"Closure of ureterocutaneous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":712.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42415","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":821.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2627","name":"Scleral cover shell","description":"Scleral cover shell","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":784.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78811","name":"Pet image ltd area","description":"Positron emission tomography (pet) imaging; limited area (eg, chest, head/neck)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26686","name":"Treat hand dislocation","description":"Open treatment of carpometacarpal dislocation, other than thumb; complex, multiple, or delayed reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15781","name":"Dermabrasion segmental face","description":"Dermabrasion; segmental, face","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20527","name":"Njx nzm palmar fascial cord","description":"Injection, enzyme (eg, collagenase), palmar fascial cord (ie, dupuytrens contracture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27306","name":"Incision of thigh tendon","description":"Tenotomy, percutaneous, adductor or hamstring; single tendon (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53010","name":"Incision of urethra","description":"Urethrotomy or urethrostomy, external (separate procedure); perineal urethra, external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86622","name":"Brucella antibody","description":"Antibody; brucella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51992","name":"Laparo sling operation","description":"Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86762","name":"Rubella antibody","description":"Antibody; rubella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55600","name":"Vesiculotomy","description":"Vesiculotomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25929","name":"Amputation follow-up surgery","description":"Transmetacarpal amputation; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82139","name":"Amino acids quan 6 or more","description":"Amino acids, 6 or more amino acids, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0471","name":"Rad w/backup non inv intrfc","description":"Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19371","name":"Peri-implt capslc brst compl","description":"Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20939","name":"Bone marrow aspir bone grfg","description":"Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95951","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1251.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27235","name":"Treat thigh fracture","description":"Percutaneous skeletal fixation of femoral fracture, proximal end, neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87526","name":"Hepatitis g dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis g, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5501","name":"Diabetic custom molded shoe","description":"For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patients foot (custom molded shoe), per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0200T","name":"Perq sacral augmt unilat inj","description":"Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59426","name":"Antepartum care only","description":"Antepartum care only; 7 or more visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11044","name":"Dbrdmt bone 1st 20 sq cm/<","description":"Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43831","name":"Gastrostomy open neonatal","description":"Gastrostomy, open; neonatal, for feeding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43453","name":"Dilate esophagus","description":"Dilation of esophagus, over guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27381","name":"Repair/graft kneecap tendon","description":"Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":680.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3919","name":"Ho w/o joints cf","description":"Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0355T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L1800","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69450","name":"Eardrum revision","description":"Tympanolysis, transcanal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92130","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77620","name":"Hyperthermia gen intrcv prb","description":"Hyperthermia generated by intracavitary probe(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3921","name":"Hfo w/joint(s) cf","description":"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58673","name":"Laparoscopy salpingostomy","description":"Laparoscopy, surgical; with salpingostomy (salpingoneostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":512.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51845","name":"Repair bladder neck","description":"Abdomino-vaginal vesical neck suspension, with or without endoscopic control (eg, stamey, raz, modified pereyra)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01272","name":"Anes px art femoral art lig","description":"Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6895","name":"Custom glove for term device","description":"Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":277.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35516","name":"Art byp grft subclav-axilary","description":"Bypass graft, with vein; subclavian-axillary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57156","name":"Ins vag brachytx device","description":"Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50387","name":"Change nephroureteral cath","description":"Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24600","name":"Tx clsd elbow dislc w/o anes","description":"Treatment of closed elbow dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24363","name":"Replace elbow joint","description":"Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1225.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36561","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0240","name":"Bath/shower chair","description":"Bath/shower chair, with or without wheels, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80439","name":"Trh stimulation panel","description":"Thyrotropin releasing hormone (trh) stimulation panel; 2 hour this panel must include the following: thyroid stimulating hormone (tsh) (84443 x 4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33263","name":"Rmvl & rplcmt dfb gen 2 lead","description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90805","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77300","name":"Radiation therapy dose plan","description":"Basic radiation dosimetry calculation, central axis depth dose calculation, tdf, nsd, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25905","name":"Amputation of forearm","description":"Amputation, forearm, through radius and ulna; open, circular (guillotine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24076","name":"Ex arm/elbow tum deep < 5 cm","description":"Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":459.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74270","name":"X-ray xm colon 1cntrst std","description":"Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77079","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0249","name":"Pad water circulating heat u","description":"Pad for water circulating heat unit, for replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00700","name":"Anes px upr ant abd wall nos","description":"Anesthesia for procedures on upper anterior abdominal wall; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33720","name":"Repair of heart defect","description":"Repair sinus of valsalva aneurysm, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96567","name":"Pdt dstr prmlg les skn","description":"Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitive drug(s), per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66761","name":"Revision of iris","description":"Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21406","name":"Opn tx orbit fx w/o implant","description":"Open treatment of fracture of orbit, except blowout; without implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":484.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74340","name":"X-ray guide for gi tube","description":"Introduction of long gastrointestinal tube (eg, miller-abbott), including multiple fluoroscopies and images, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99394","name":"Prev visit est age 12-17","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27732","name":"Repair of fibula epiphysis","description":"Arrest, epiphyseal (epiphysiodesis), open; distal fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95721","name":"Eeg phy/qhp>36<60 hr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 36 hours, up to 60 hours of eeg recording, without video","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58952","name":"Resect ovarian malignancy","description":"Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with radical dissection for debulking (ie, radical excision or destruction, intra-abdominal or retroperitoneal tumors)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1039.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1090","name":"Lumbar sling","description":"Addition to ctlso or scoliosis orthosis, lumbar sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44377","name":"Small bowel endoscopy/biopsy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92971","name":"Cardioassist external","description":"Cardioassist-method of circulatory assist; external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5200","name":"Percutaneous catheter anchor","description":"Percutaneous catheter/tube anchoring device, adhesive skin attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43774","name":"Lap rmvl gastr adj all parts","description":"Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":803.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21013","name":"Exc face tum deep < 2 cm","description":"Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); less than 2 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36252","name":"Ins cath ren art 1st bilat","description":"Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and inte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1232.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5790","name":"Exoskeletal ak ultra-light m","description":"Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82120","name":"Amines vaginal fluid qual","description":"Amines, vaginal fluid, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41250","name":"Repair tongue laceration","description":"Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":218.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96425","name":"Chemotherapy infusion method","description":"Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43234","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":221.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59121","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83060","name":"Hgb sulfhemoglobin quan","description":"Hemoglobin; sulfhemoglobin, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88300","name":"Surgical path gross","description":"Level i - surgical pathology, gross examination only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38520","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":304.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0650","name":"Lso sc r ant/pos pnl pre ots","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, inclu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78800","name":"Rp loclzj tum 1 area 1 d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (eg, head, neck, chest, pelvis), single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45108","name":"Anorectal myomectomy","description":"Anorectal myomectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":306.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6245","name":"Hydrogel drg <= 16 in w/bdr","description":"Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4252","name":"Blood ketone test or strip","description":"Blood ketone test or reagent strip, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92565","name":"Stenger test pure tone","description":"Stenger test, pure tone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42227","name":"Lengthening of palate","description":"Lengthening of palate, with island flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96138","name":"Psycl/nrpsyc tech 1st","description":"Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1070","name":"Trapezius sling","description":"Addition to ctlso or scoliosis orthosis, trapezius sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22327","name":"Treat thorax spine fracture","description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1341.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4623","name":"Tracheostomy inner cannula","description":"Tracheostomy, inner cannula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0031A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95910","name":"Nrv cndj test 7-8 studies","description":"Nerve conduction studies; 7-8 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86300","name":"Immunoassay tumor ca 15-3","description":"Immunoassay for tumor antigen, quantitative; ca 15-3 (27.29)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31375","name":"Partial removal of larynx","description":"Partial laryngectomy (hemilaryngectomy); laterovertical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55810","name":"Extensive prostate surgery","description":"Prostatectomy, perineal radical;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80069","name":"Renal function panel","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 (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12018","name":"Rpr f/e/e/n/l/m >30.0 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64575","name":"Opn impltj nea perph nerve","description":"Open implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36904","name":"Thrmbc/nfs dialysis circuit","description":"Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thromboly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47715","name":"Excision of bile duct cyst","description":"Excision of choledochal cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27381","name":"Repair/graft kneecap tendon","description":"Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47500","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76932","name":"Echo guide for heart biopsy","description":"Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15110","name":"Epidrm agrft t/a/l 1st 100","description":"Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82160","name":"Assay of androsterone","description":"Androsterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80201","name":"Assay of topiramate","description":"Topiramate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97033","name":"App mdlty 1+iontphrsis ea 15","description":"Application of a modality to 1 or more areas; iontophoresis, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37231","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7046.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82286","name":"Assay of bradykinin","description":"Bradykinin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5661","name":"Multi-durometer symes","description":"Addition to lower extremity, socket insert, multi-durometer symes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11423","name":"Exc h-f-nk-sp b9+marg 2.1-3","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01860","name":"Anes forearm wrist/hand cast","description":"Anesthesia for forearm, wrist, or hand cast application, removal, or repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87186","name":"Sc std microdil/agar dil","description":"Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [mic] or breakpoint), each multi-antimicrobial, per plate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8330","name":"Truss add to std pad scrotal","description":"Truss, addition to standard pad, scrotal pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55650","name":"Remove sperm duct pouch","description":"Vesiculectomy, any approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":580.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87501","name":"Influenza dna amp prob 1+","description":"Infectious agent detection by nucleic acid (dna or rna); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15650","name":"Transfer skin pedicle flap","description":"Transfer, intermediate, of any pedicle flap (eg, abdomen to wrist, walking tube), any location","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":319.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21433","name":"Optx cranfcl sep comp mlt","description":"Open treatment of craniofacial separation (lefort iii type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1465.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77318","name":"Brachytx isodose complex","description":"Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95981","name":"Io anal gast n-stim subsq","description":"Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28755","name":"Fusion of big toe joint","description":"Arthrodesis, great toe; interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87580","name":"M.pneumon dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycoplasma pneumoniae, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24300","name":"Mnpj elbow under anes","description":"Manipulation, elbow, under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45160","name":"Excision of rectal lesion","description":"Excision of rectal tumor by proctotomy, transsacral or transcoccygeal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50551","name":"Kidney endoscopy","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33220","name":"Repair lead pace-defib dual","description":"Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1816","name":"Sps/pass ankle device","description":"Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93459","name":"L hrt art/grft angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter place","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27829","name":"Treat lower leg joint","description":"Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95861","name":"Needle emg 2 extremities","description":"Needle electromyography; 2 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0323","name":"Care manage beh svs 20mins","description":"Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-u","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63740","name":"Install spinal shunt","description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; including laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27391","name":"Incision of thigh tendons","description":"Tenotomy, open, hamstring, knee to hip; multiple tendons, 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":473.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46200","name":"Removal of anal fissure","description":"Fissurectomy, including sphincterotomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87633","name":"Resp virus 12-25 targets","description":"Infectious agent detection by nucleic acid (dna or rna); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":162.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49651","name":"Lap ing hernia repair recur","description":"Laparoscopy, surgical; repair recurrent inguinal hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":464.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45398","name":"Colonoscopy w/band ligation","description":"Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61703","name":"Clamp neck artery","description":"Surgery of intracranial aneurysm, cervical approach by application of occluding clamp to cervical carotid artery (selverstone-crutchfield type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1238.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43266","name":"Egd endoscopic stent place","description":"Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61571","name":"Incise skull for brain wound","description":"Craniectomy or craniotomy; with treatment of penetrating wound of brain","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97761","name":"Prosthetic traing 1st enc","description":"Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25450","name":"Epiphysl arrst dstl rds/ulna","description":"Epiphyseal arrest by epiphysiodesis or stapling; distal radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":520.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87207","name":"Smear special stain","description":"Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21440","name":"Cltx mndblr/max alv ridge fx","description":"Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0764","name":"Functional neuromuscularstim","description":"Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47536","name":"Exchange biliary drg cath","description":"Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":535.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8002","name":"Brst prsth bra & bilat form","description":"Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92546","name":"Sinusoidal rotational test","description":"Sinusoidal vertical axis rotational testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20605","name":"Drain/inj joint/bursa w/o us","description":"Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2037","name":"Kafo plas sing free knee mol","description":"Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33332","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1054.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0585","name":"Nebulizer w/ compressor & he","description":"Nebulizer, with compressor and heater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28010","name":"Incision of toe tendon","description":"Tenotomy, percutaneous, toe; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25446","name":"Arthrp w/prostc dst rds&crps","description":"Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92285","name":"External ocular photography","description":"External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, slit lamp photography, goniophotography, stereo-photography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19085","name":"Bx breast 1st lesion mr imag","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74355","name":"X-ray guide intestinal tube","description":"Percutaneous placement of enteroclysis tube, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7045","name":"Pediatric electric hook","description":"Electric hook, switch or myoelectric controlled, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15945","name":"Exc isch pr ulc skn flp ostc","description":"Excision, ischial pressure ulcer, with skin flap closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50610","name":"Removal of ureter stone","description":"Ureterolithotomy; upper one-third of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":764.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29824","name":"Sho arthrs srg dstl claviclc","description":"Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (mumford procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76516","name":"Echo exam of eye","description":"Ophthalmic biometry by ultrasound echography, a-scan;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61460","name":"Crnec sopl sctj 1+crnl nrv","description":"Craniectomy, suboccipital; for section of 1 or more cranial nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0181","name":"Press pad alternating w/ pum","description":"Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21603","name":"Exc ch wal tum w/lymphadec","description":"Excision of chest wall tumor involving rib(s), with plastic reconstruction; with mediastinal lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1509.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44382","name":"Small bowel endoscopy","description":"Ileoscopy, through stoma; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":220.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17271","name":"Dstr mal les s/n/h/f/g 0.6-1","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24320","name":"Tenoplasty elbow to sho 1","description":"Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder, single (seddon-brookes type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":660.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76101","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4193","name":"Parenteral sol 52-73 gm prot","description":"Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15783","name":"Dermabrasion suprfl any site","description":"Dermabrasion; superficial, any site (eg, tattoo removal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0506","name":"Comp asses care plan ccm svc","description":"Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27517","name":"Treat thigh fx growth plate","description":"Closed treatment of distal femoral epiphyseal separation; with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":579.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49427","name":"Injection abdominal shunt","description":"Injection procedure (eg, contrast media) for evaluation of previously placed peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7029","name":"Repl nasal pillow comb mask","description":"Nasal pillows for combination oral/nasal mask, replacement only, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0110T","name":"Nos quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using other stimuli to assess sensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25420","name":"Repair/graft radius & ulna","description":"Repair of nonunion or malunion, radius and ulna; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78830","name":"Rp loclzj tum spect w/ct 1","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect) with concurrently acquired computed tomography (ct) transmission scan for anatomical review, localizati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26850","name":"Fusion of knuckle","description":"Arthrodesis, metacarpophalangeal joint, with or without internal fixation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":585.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85598","name":"Hexagnal phosph pltlt neutrl","description":"Phospholipid neutralization; hexagonal phospholipid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28202","name":"Repair/graft of foot tendon","description":"Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2340","name":"W/c wdth 20-23 in seat frame","description":"Power wheelchair accessory, nonstandard seat frame width, 20-23 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93244","name":"Ext ecg>48hr<7d rev&interpj","description":"External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; review and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00172","name":"Anes ntroral px rpr clft pal","description":"Anesthesia for intraoral procedures, including biopsy; repair of cleft palate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1083","name":"Hemi-wheelchair fixed arms","description":"Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10009","name":"Fna bx w/ct gdn 1st les","description":"Fine needle aspiration biopsy, including ct guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17312","name":"Mohs addl stage","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), h","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4034","name":"Enter feed supkit syr by day","description":"Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77610","name":"Hyperthermia ntrstl prb 5/<","description":"Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29830","name":"Elbow arthroscopy","description":"Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88275","name":"Cytogenetics 100-300","description":"Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0967","name":"Man wc rim/projection rep ea","description":"Manual wheelchair accessory, hand rim with projections, any type, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64645","name":"Chemodenerv 1 extrem 5/> ea","description":"Chemodenervation of one extremity; each additional extremity, 5 or more muscles (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20663","name":"Application halo femoral","description":"Application of halo, including removal; femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2088","name":"Off base opioid tx, add30","description":"Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33755","name":"Shunt as-aort to pulm art","description":"Shunt; ascending aorta to pulmonary artery (waterston type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55862","name":"Extensive prostate surgery","description":"Exposure of prostate, any approach, for insertion of radioactive substance; with lymph node biopsy(s) (limited pelvic lymphadenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":887.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59618","name":"Attempted vbac delivery","description":"Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2108.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66700","name":"Destruction ciliary body","description":"Ciliary body destruction; diathermy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76816","name":"Ob us follow-up per fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62361","name":"Implant spine infusion pump","description":"Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64902","name":"Nerve graft add-on","description":"Nerve graft, each additional nerve; multiple strands (cable) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":591.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76965","name":"Echo guidance radiotherapy","description":"Ultrasonic guidance for interstitial radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11620","name":"Exc h-f-nk-sp mal+marg 0.5/<","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23505","name":"Cltx clavicular fx w/mnpj","description":"Closed treatment of clavicular fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82043","name":"Ur albumin quantitative","description":"Albumin; urine (eg, microalbumin), quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50400","name":"Revision of kidney/ureter","description":"Pyeloplasty (foley y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":946.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0003","name":"Lightweight wheelchair","description":"Lightweight wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2112","name":"Spherocylindr 7.25d/2.25-4d","description":"Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0186","name":"Air pressure mattress","description":"Air pressure mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2011","name":"Alcohol/sub misuse assess","description":"Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1907","name":"Afo supramalleolar custom","description":"Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":274.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31643","name":"Diag bronchoscope/catheter","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of catheter(s) for intracavitary radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27558","name":"Treat knee dislocation","description":"Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair, with augmentation/reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1013.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55812","name":"Extensive prostate surgery","description":"Prostatectomy, perineal radical; with lymph node biopsy(s) (limited pelvic lymphadenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1301.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59320","name":"Revision of cervix","description":"Cerclage of cervix, during pregnancy; vaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":133.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0947","name":"Fracture frame attachmnts pe","description":"Fracture frame, attachments for complex pelvic traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0857","name":"Pwc gp3 std sing pow opt cap","description":"Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70371","name":"Speech evaluation complex","description":"Complex dynamic pharyngeal and speech evaluation by cine or video recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99393","name":"Prev visit est age 5-11","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10061","name":"I&d abscess comp/multiple","description":"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58615","name":"Occlude fallopian tube(s)","description":"Occlusion of fallopian tube(s) by device (eg, band, clip, falope ring) vaginal or suprapubic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32670","name":"Thoracoscopy bilobectomy","description":"Thoracoscopy, surgical; with removal of two lobes (bilobectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1282.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99350","name":"Home/res vst est high mdm 60","description":"Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1008","name":"Pwr seat combo pwr shear","description":"Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0222T","name":"Plmt post facet implt addl","description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01844","name":"Anes vasc shunt/shunt revj","description":"Anesthesia for vascular shunt, or shunt revision, any type (eg, dialysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23200","name":"Radical rescj tumor clavicle","description":"Radical resection of tumor; clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1280.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4565","name":"Slings","description":"Slings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10006","name":"Fna bx w/us gdn ea addl","description":"Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65430","name":"Corneal smear","description":"Scraping of cornea, diagnostic, for smear and/or culture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00952","name":"Anes vag px hystsc&/hsg","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95714","name":"Veeg ea 12-26 hr unmntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, each increment of 12-26 hours; unmonitored","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93615","name":"Esophageal recording","description":"Esophageal recording of atrial electrogram with or without ventricular electrogram(s);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24565","name":"Cltx hum epcndylr fx w/mnpj","description":"Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":449.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26110","name":"Biopsy finger joint lining","description":"Arthrotomy with biopsy; interphalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77525","name":"Proton treatment complex","description":"Proton treatment delivery; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":748.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27690","name":"Revise lower leg tendon","description":"Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00868","name":"Anes xtrprtl px rnl transpl","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal transplant (recipient)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0429","name":"Dermal filler injection(s)","description":"Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0113","name":"Crutch underarm each wood","description":"Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2109","name":"Spherocylinder 4.25d/4.25-6d","description":"Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61590","name":"Infratemporal approach/skull","description":"Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline skull base, nasopharynx), with or without disarticulation of the mandible, including parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve and/or petrous carotid a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6240","name":"Hydrocolld drg filler paste","description":"Hydrocolloid dressing, wound filler, paste, sterile, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46270","name":"Remove anal fist subq","description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99409","name":"Audit/dast over 30 min","description":"Alcohol and/or substance (other than tobacco) abuse structured screening (eg, audit, dast), and brief intervention (sbi) services; greater than 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48520","name":"Fuse pancreas cyst and bowel","description":"Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":911.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77605","name":"Hyperthermia ext gen deep","description":"Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25651","name":"Perq skel fix ulnar styld fx","description":"Percutaneous skeletal fixation of ulnar styloid fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0546T","name":"Rf spectrsc ntraop mrgn asmt","description":"Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26372","name":"Repair/graft hand tendon","description":"Repair or advancement of profundus tendon, with intact superficialis tendon; secondary with free graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0673","name":"Pressure pneum appl half leg","description":"Segmental gradient pressure pneumatic appliance, half leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56640","name":"Vlvctmy rad comp w/lymphadec","description":"Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92565","name":"Stenger test pure tone","description":"Stenger test, pure tone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20200","name":"Muscle biopsy superficial","description":"Biopsy, muscle; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35663","name":"Bpg ilioiliac","description":"Bypass graft, with other than vein; ilioiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1073.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0292","name":"Hosp bed var ht no sr w/matt","description":"Hospital bed, variable height, hi-lo, without side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60100","name":"Biopsy of thyroid","description":"Biopsy thyroid, percutaneous core needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94370","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92145","name":"Corneal hysteresis deter","description":"Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25136","name":"Remove & graft wrist lesion","description":"Excision or curettage of bone cyst or benign tumor of carpal bones; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":417.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31781","name":"Reconstruct windpipe","description":"Excision tracheal stenosis and anastomosis; cervicothoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5540","name":"Prep bk ptb laminated socket","description":"Preparatory, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4247","name":"Betadine/iodine swabs/wipes","description":"Betadine or iodine swabs/wipes, per box","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37188","name":"Ven mechnl thrmbc repeat tx","description":"Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93351","name":"Stress tte complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7367","name":"Replacemnt lithium ionbatter","description":"Lithium ion battery, rechargeable, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58552","name":"Laparo-vag hyst incl t/o","description":"Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":631.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25430","name":"Vasc graft into carpal bone","description":"Insertion of vascular pedicle into carpal bone (eg, hori procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":615.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86688","name":"Htlv-ii antibody","description":"Antibody; htlv-ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27078","name":"Rsect hip tum incl femur","description":"Radical resection of tumor; ischial tuberosity and greater trochanter of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1752.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4246","name":"Betadine/phisohex solution","description":"Betadine or phisohex solution, per pint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43653","name":"Laparoscopy gastrostomy","description":"Laparoscopy, surgical; gastrostomy, without construction of gastric tube (eg, stamm procedure) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9040","name":"Rbc leukoreduced irradiated","description":"Red blood cells, leukocytes reduced, irradiated, each unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5850","name":"Endo ak/hip knee extens assi","description":"Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67912","name":"Correction eyelid w/implant","description":"Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":556.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80410","name":"Calcitonin stimul panel","description":"Calcitonin stimulation panel (eg, calcium, pentagastrin) this panel must include the following: calcitonin (82308 x 3)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4350","name":"Ankle control ortho pre ots","description":"Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73140","name":"X-ray exam of finger(s)","description":"Radiologic examination, finger(s), minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1080","name":"Outrigger","description":"Addition to ctlso or scoliosis orthosis, outrigger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27620","name":"Explore/treat ankle joint","description":"Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23460","name":"Repair shoulder capsule","description":"Capsulorrhaphy, anterior, any type; with bone block","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":921.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23210","name":"Radical rescj tumor scapula","description":"Radical resection of tumor; scapula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51700","name":"Irrigation of bladder","description":"Bladder irrigation, simple, lavage and/or instillation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0636","name":"Pt support & positioning sys","description":"Multipositional patient support system, with integrated lift, patient accessible controls","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96912","name":"Photochemotherapy puva","description":"Photochemotherapy; psoralens and ultraviolet a (puva)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0290","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1840.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2101","name":"Bld glucose monitor w lance","description":"Blood glucose monitor with integrated lancing/blood sample","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33612","name":"Repair double ventricle","description":"Repair of double outlet right ventricle with intraventricular tunnel repair; with repair of right ventricular outflow tract obstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92313","name":"C-lens fitg corneosclrl lens","description":"Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64450","name":"Njx aa&/strd other pn/branch","description":"Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23570","name":"Cltx scapular fx w/o mnpj","description":"Closed treatment of scapular fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97755","name":"Assistive technology assess","description":"Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57288","name":"Repair bladder defect","description":"Sling operation for stress incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":463.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5962","name":"Below knee flex cover system","description":"Addition, endoskeletal system, below knee, flexible protective outer surface covering system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":292.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35741","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":432.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35472","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1484.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84586","name":"Assay of vip","description":"Vasoactive intestinal peptide (vip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47125","name":"Partial removal of liver","description":"Hepatectomy, resection of liver; total left lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2580.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34530","name":"Leg vein fusion","description":"Saphenopopliteal vein anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":508.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95060","name":"Oph mucous membrane tests","description":"Ophthalmic mucous membrane tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35501","name":"Art byp grft ipsilat carotid","description":"Bypass graft, with vein; common carotid-ipsilateral internal carotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1290.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35001","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, carotid, subclavian artery, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44379","name":"S bowel endoscope w/stent","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with transendoscopic stent placement (includes predilation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4215","name":"Sterile needle","description":"Needle, sterile, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34842","name":"Endovasc visc aorta 2 graft","description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1156.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36246","name":"Ins cath abd/l-ext art 2nd","description":"Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19307","name":"Mast mod rad","description":"Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":805.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78469","name":"Heart infarct image (3d)","description":"Myocardial imaging, infarct avid, planar; tomographic spect with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63090","name":"Remove vert body dcmprn lmbr","description":"Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5052","name":"Clsd ostomy pouch w/o barr","description":"Ostomy pouch, closed; without barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76817","name":"Transvaginal us obstetric","description":"Ultrasound, pregnant uterus, real time with image documentation, transvaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43305","name":"Repair esophagus and fistula","description":"Esophagoplasty (plastic repair or reconstruction), cervical approach; with repair of tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29520","name":"Strapping of hip","description":"Strapping; hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15842","name":"Nerve palsy microsurg graft","description":"Graft for facial nerve paralysis; free muscle flap by microsurgical technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34844","name":"Endovasc visc aorta 4 graft","description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1632.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88187","name":"Flowcytometry/read 2-8","description":"Flow cytometry, interpretation; 2 to 8 markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64895","name":"Nrv grf mltst hnd/foot <4 cm","description":"Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36908","name":"Stent plmt ctr dialysis seg","description":"Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (list separately in addition to","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1045.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1250","name":"Anterior asis pad","description":"Addition to tlso, (low profile), anterior asis pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2225","name":"Caster wheel excludes tire","description":"Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"S3818","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41017","name":"Drainage of mouth lesion","description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submandibular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22818","name":"Kyphectomy 1-2 segments","description":"Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1841.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83065","name":"Hemoglobin thermolabile","description":"Hemoglobin; thermolabile","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36590","name":"Removal tunneled cv cath","description":"Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33507","name":"Repair art intramural","description":"Repair of anomalous (eg, intramural) aortic origin of coronary artery by unroofing or translocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1498.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4153","name":"Ef hydrolyzed/amino acids","description":"Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7368","name":"Lithium ion battery charger","description":"Lithium ion battery charger, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58605","name":"Division of fallopian tube","description":"Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13102","name":"Cmplx rpr trunk addl 5cm/<","description":"Repair, complex, trunk; each additional 5 cm or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7368","name":"Lithium ion battery charger","description":"Lithium ion battery charger, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78350","name":"Bone mineral single photon","description":"Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33781","name":"Rpr tga rcnstj rpr sbpl obst","description":"Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, jatene type); with repair of subpulmonic obstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2017.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80069","name":"Renal function panel","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 (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63307","name":"Remov vert idrl bdy lmbr/sac","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, lumbar or sacral by transperitoneal or retroperitoneal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84442","name":"Assay of thyroid activity","description":"Thyroxine binding globulin (tbg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80439","name":"Trh stimulation panel","description":"Thyrotropin releasing hormone (trh) stimulation panel; 2 hour this panel must include the following: thyroid stimulating hormone (tsh) (84443 x 4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93620","name":"Comp ep evl r at ven pac&rec","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, his bundle recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9275","name":"Disp home glucose monitor","description":"Home glucose disposable monitor, includes test strips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21240","name":"Reconstruction of jaw joint","description":"Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92508","name":"Tx sp lang voice comm group","description":"Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27768","name":"Cltx post ankle fx w/mnpj","description":"Closed treatment of posterior malleolus fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":371.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86147","name":"Cardiolipin antibody ea ig","description":"Cardiolipin (phospholipid) antibody, each ig class","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32652","name":"Thoracoscopy rem totl cortex","description":"Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10009","name":"Fna bx w/ct gdn 1st les","description":"Fine needle aspiration biopsy, including ct guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":376.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31622","name":"Dx bronchoscope/wash","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0441T","name":"Abltj perc lxtr/perph nrv","description":"Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69637","name":"Rebuild eardrum structures","description":"Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [porp], total ossicular replacement prosthesis [torp])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1110.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4045","name":"Replace non-molded thigh lac","description":"Replace non-molded thigh lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23430","name":"Repair biceps tendon","description":"Tenodesis of long tendon of biceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":626.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74230","name":"X-ray xm swlng funcj c+","description":"Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86485","name":"Skin test candida","description":"Skin test; candida","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21048","name":"Remove maxilla cyst complex","description":"Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":848.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1825","name":"Adjust finger ext & flex dev","description":"Dynamic adjustable finger extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77771","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77077","name":"Joint survey single view","description":"Joint survey, single view, 2 or more joints (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53080","name":"Drainage of urinary leakage","description":"Drainage of perineal urinary extravasation; uncomplicated (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50592","name":"Perc rf ablate renal tumor","description":"Ablation, 1 or more renal tumor(s), percutaneous, unilateral, radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93668","name":"Peripheral vascular rehab","description":"Peripheral arterial disease (pad) rehabilitation, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13101","name":"Cmplx rpr trunk 2.6-7.5 cm","description":"Repair, complex, trunk; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67412","name":"Explore/treat eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":558.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5636","name":"Symes type medial opening so","description":"Addition to lower extremity, symes type, medial opening socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95130","name":"Immntx 1 sting insect","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single stinging insect venom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95909","name":"Nrv cndj tst 5-6 studies","description":"Nerve conduction studies; 5-6 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4539","name":"Reuse diaper/brief any size","description":"Incontinence product, diaper/brief, reusable, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30903","name":"Control of nosebleed","description":"Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51736","name":"Urine flow measurement","description":"Simple uroflowmetry (ufr) (eg, stop-watch flow rate, mechanical uroflowmeter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65130","name":"Insert ocular implant","description":"Insertion of ocular implant secondary; after evisceration, in scleral shell","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":477.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82670","name":"Assay of total estradiol","description":"Estradiol; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0823","name":"Pwc gp 2 std cap chair","description":"Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87255","name":"Genet virus isolate hsv","description":"Virus isolation; including identification by non-immunologic method, other than by cytopathic effect (eg, virus specific enzymatic activity)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43250","name":"Egd cautery tumor polyp","description":"Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86156","name":"Cold agglutinin screen","description":"Cold agglutinin; screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2220","name":"Lens bifocal add over 3.25d","description":"Bifocal add over 3.25d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73050","name":"X-ray exam of shoulders","description":"Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55812","name":"Extensive prostate surgery","description":"Prostatectomy, perineal radical; with lymph node biopsy(s) (limited pelvic lymphadenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19100","name":"Bx breast percut w/o image","description":"Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4030","name":"Replace socket brim cust fit","description":"Replace quadrilateral socket brim, custom fitted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32560","name":"Treat pleurodesis w/agent","description":"Instillation, via chest tube/catheter, agent for pleurodesis (eg, talc for recurrent or persistent pneumothorax)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15840","name":"Nerve palsy fascial graft","description":"Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":635.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88106","name":"Cytopath fl nongyn filter","description":"Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63081","name":"Remove vert body dcmprn crvl","description":"Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4419","name":"Ost pch for bar w flange/flt","description":"Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54401","name":"Insert self-contd prosthesis","description":"Insertion of penile prosthesis; inflatable (self-contained)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":532.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59812","name":"Treatment of miscarriage","description":"Treatment of incomplete abortion, any trimester, completed surgically","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57410","name":"Pelvic examination","description":"Pelvic examination under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83520","name":"Immunoassay quant nos nonab","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94010","name":"Breathing capacity test","description":"Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28240","name":"Release of big toe","description":"Tenotomy, lengthening, or release, abductor hallucis muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76998","name":"Us guide intraop","description":"Ultrasonic guidance, intraoperative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47605","name":"Cholecystectomy w/cholang","description":"Cholecystectomy; with cholangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92613","name":"Endoscopy swallow (fees) i&r","description":"Flexible endoscopic evaluation of swallowing by cine or video recording; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62120","name":"Repair skull cavity lesion","description":"Repair of encephalocele, skull vault, including cranioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43108","name":"Removal of esophagus","description":"Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3730.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63078","name":"Spine disk surgery thorax","description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74022","name":"Radex compl aqt abd series","description":"Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86606","name":"Aspergillus antibody","description":"Antibody; aspergillus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60210","name":"Partial thyroid excision","description":"Partial thyroid lobectomy, unilateral; with or without isthmusectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82978","name":"Assay of glutathione","description":"Glutathione","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1846","name":"Ko w adj flex/ext rotat mold","description":"Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":628.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32124","name":"Explore chest free adhesions","description":"Thoracotomy; with open intrapleural pneumonolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":738.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72240","name":"Myelography neck spine","description":"Myelography, cervical, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0500","name":"Filters elec/combo vad, rep","description":"Filters for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43843","name":"Gstr rstcv oth/thn v-band","description":"Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31661","name":"Bronch thermoplsty 2/> lobes","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54100","name":"Biopsy of penis","description":"Biopsy of penis; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0124","name":"Screen c/v thin layer by md","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47740","name":"Fuse gallbladder & bowel","description":"Cholecystoenterostomy; roux-en-y","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1100.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43772","name":"Lap rmvl gastr adj device","description":"Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51784","name":"Anal/urinary muscle study","description":"Electromyography studies (emg) of anal or urethral sphincter, other than needle, any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25535","name":"Cltx ulnar shft fx w/mnpj","description":"Closed treatment of ulnar shaft fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43263","name":"Ercp sphincter pressure meas","description":"Endoscopic retrograde cholangiopancreatography (ercp); with pressure measurement of sphincter of oddi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86652","name":"Encephaltis east eqne anbdy","description":"Antibody; encephalitis, eastern equine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94375","name":"Respiratory flow volume loop","description":"Respiratory flow volume loop","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95012","name":"Nitric oxide exp gas deter","description":"Nitric oxide expired gas determination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20693","name":"Adjmt/revj ext fixj sys anes","description":"Adjustment or revision of external fixation system requiring anesthesia (eg, new pin[s] or wire[s] and/or new ring[s] or bar[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":366.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50100","name":"Trnsxj/repos abrrnt rnl vsls","description":"Transection or repositioning of aberrant renal vessels (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":947.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92140","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25660","name":"Cltx rdcrpl/ntrcrpl dislc 1+","description":"Closed treatment of radiocarpal or intercarpal dislocation, 1 or more bones, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69915","name":"Incise inner ear nerve","description":"Vestibular nerve section, translabyrinthine approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1228.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95723","name":"Eeg phy/qhp>60<84 hr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 60 hours, up to 84 hours of eeg recording, without video","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B9006","name":"Parenteral infus pump statio","description":"Parenteral nutrition infusion pump, stationary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81343","name":"Ppp2r2b gen detc abnor allel","description":"Ppp2r2b (protein phosphatase 2 regulatory subunit bbeta) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64476","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24140","name":"Partial exc bone humerus","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":591.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87497","name":"Cytomeg dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); cytomegalovirus, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69105","name":"Biopsy of external ear canal","description":"Biopsy external auditory canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38780","name":"Remove abdomen lymph nodes","description":"Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0034A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49905","name":"Omental flap intra-abdom","description":"Omental flap, intra-abdominal (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33285","name":"Insj subq car rhythm mntr","description":"Insertion, subcutaneous cardiac rhythm monitor, including programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27422","name":"Revision of unstable kneecap","description":"Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, campbell, goldwaite type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84425","name":"Assay of vitamin b-1","description":"Thiamine (vitamin b-1)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28264","name":"Release of midfoot joint","description":"Capsulotomy, midtarsal (eg, heyman type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81173","name":"Ar gene full gene sequence","description":"Ar (androgen receptor) (eg, spinal and bulbar muscular atrophy, kennedy disease, x chromosome inactivation) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93230","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38207","name":"Cryopreserve stem cells","description":"Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8400","name":"Sheath below knee","description":"Prosthetic sheath, below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43361","name":"Gastrointestinal repair","description":"Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2264.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0249","name":"Provide inr test mater/equip","description":"Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31613","name":"Tracheostoma revj simple","description":"Tracheostoma revision; simple, without flap rotation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":329.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01173","name":"Anes opn rpr fx disrpj plvs","description":"Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58661","name":"Laparoscopy remove adnexa","description":"Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":417.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95822","name":"Eeg coma or sleep only","description":"Electroencephalogram (eeg); recording in coma or sleep only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27339","name":"Exc thigh/knee tum dep 5cm/>","description":"Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29861","name":"Hip arthro w/fb removal","description":"Arthroscopy, hip, surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":607.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99232","name":"Sbsq hosp ip/obs moderate 35","description":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 35 minut","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17282","name":"Dstr mal ls f/e/e/n/l/m1.1-2","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22870","name":"Insj stablj dev w/o dcmprn","description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4463","name":"Surgical dress holder reuse","description":"Surgical dressing holder, reusable, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96158","name":"Hlth bhv ivntj indiv 1st 30","description":"Health behavior intervention, individual, face-to-face; initial 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74740","name":"X-ray female genital tract","description":"Hysterosalpingography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L7260","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":976.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22505","name":"Manipulation of spine","description":"Manipulation of spine requiring anesthesia, any region","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93624","name":"Ep f-up study pacg&rec","description":"Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82715","name":"Assay of fecal fat","description":"Fat differential, feces, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2374","name":"Hand/chin ctrl std joystick","description":"Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35538","name":"Art byp grft aortobi-iliac","description":"Bypass graft, with vein; aortobi-iliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2069.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95938","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28600","name":"Treat foot dislocation","description":"Closed treatment of tarsometatarsal joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93025","name":"Microvolt t-wave assess","description":"Microvolt t-wave alternans for assessment of ventricular arrhythmias","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0353T","name":"Intraop oct breast cavity","description":"Optical coherence tomography of breast, surgical cavity; real-time intraoperative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82190","name":"Atomic absorption","description":"Atomic absorption spectroscopy, each analyte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59320","name":"Revision of cervix","description":"Cerclage of cervix, during pregnancy; vaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77318","name":"Brachytx isodose complex","description":"Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31511","name":"Remove foreign body larynx","description":"Laryngoscopy, indirect; with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51605","name":"Preparation for bladder xray","description":"Injection procedure and placement of chain for contrast and/or chain urethrocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4417","name":"Ost pch w bar/bltinconv/fltr","description":"Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5530","name":"Prep bk ptb thermopls molded","description":"Preparatory, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":857.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27132","name":"Total hip arthroplasty","description":"Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85303","name":"Clot inhibit prot c activity","description":"Clotting inhibitors or anticoagulants; protein c, activity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87660","name":"Trichomonas vagin dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); trichomonas vaginalis, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97018","name":"Paraffin bath therapy","description":"Application of a modality to 1 or more areas; paraffin bath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0472","name":"Tlso rigid frame hyperex pre","description":"Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71101","name":"X-ray exam unilat ribs/chest","description":"Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85670","name":"Thrombin time plasma","description":"Thrombin time; plasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0786","name":"Implantable pump replacement","description":"Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21076","name":"Impres&prep surg obt prosth","description":"Impression and custom preparation; surgical obturator prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58294","name":"Vag hyst w/enterocele compl","description":"Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":784.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78609","name":"Brain imaging (pet)","description":"Brain imaging, positron emission tomography (pet); perfusion evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87046","name":"Stool cultr aerobic bact ea","description":"Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0316","name":"Prolong inpt eval add15 m","description":"Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75635","name":"Ct angio abdominal arteries","description":"Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32440","name":"Remove lung pneumonectomy","description":"Removal of lung, pneumonectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1251.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44500","name":"Intro gastrointestinal tube","description":"Introduction of long gastrointestinal tube (eg, miller-abbott) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26185","name":"Remove finger bone","description":"Sesamoidectomy, thumb or finger (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69633","name":"Rebuild eardrum structures","description":"Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [porp], total ossicular replacement prosthesis [torp])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":842.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28300","name":"Incision of heel bone","description":"Osteotomy; calcaneus (eg, dwyer or chambers type procedure), with or without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":538.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33534","name":"Cabg arterial two","description":"Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61735","name":"Incise skull/brain surgery","description":"Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; subcortical structure(s) other than globus pallidus or thalamus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1453.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93786","name":"Ambl bp mntr w/sw rec only","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; recording only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80196","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84488","name":"Test feces for trypsin","description":"Trypsin; feces, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49450","name":"Replace g/c tube perc","description":"Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75630","name":"X-ray aorta leg arteries","description":"Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22614","name":"Arthrd pst tq 1ntrspc ea add","description":"Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56630","name":"Vulvectomy radical partial","description":"Vulvectomy, radical, partial;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66761","name":"Revision of iris","description":"Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0454","name":"Md document visit by npp","description":"Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3980","name":"Up ext fx orthos humeral nos","description":"Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01474","name":"Anes gastrocnemius recession","description":"Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, strayer procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28315","name":"Removal of sesamoid bone","description":"Sesamoidectomy, first toe (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28160","name":"Partial removal of toe","description":"Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57170","name":"Fitting of diaphragm/cap","description":"Diaphragm or cervical cap fitting with instructions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87492","name":"Chlmyd trach dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia trachomatis, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27369","name":"Njx cntrst kne arthg/ct/mri","description":"Injection procedure for contrast knee arthrography or contrast enhanced ct/mri knee arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19367","name":"Brst rcnstj 1 pdcl tram flap","description":"Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (tram) flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1150.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36596","name":"Mech remov tunneled cv cath","description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9021","name":"Red blood cells unit","description":"Red blood cells, each unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88369","name":"M/phmtrc alysishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6453","name":"Self-adher band w <3in/yd","description":"Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26676","name":"Pin hand dislocation","description":"Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":420.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4425","name":"Ost pch drain for barrier fl","description":"Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65805","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70552","name":"Mri brain stem w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2220","name":"Dorsi & plantar flex ass/res","description":"Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94452","name":"Hast w/i&r phys/qhp","description":"High altitude simulation test (hast), with interpretation and report by a physician or other qualified health care professional;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99157","name":"Mod sed other phys/qhp ea","description":"Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time (list separate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93272","name":"Ecg/review interpret only","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43211","name":"Esophagoscop mucosal resect","description":"Esophagoscopy, flexible, transoral; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86309","name":"Heterophile antibody titer","description":"Heterophile antibodies; titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3980","name":"Up ext fx orthos humeral nos","description":"Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25607","name":"Optx dst rd xartc fx/epi sep","description":"Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":616.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1846","name":"Ko w adj flex/ext rotat mold","description":"Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64575","name":"Opn impltj nea perph nerve","description":"Open implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8440","name":"Shrinker below knee","description":"Prosthetic shrinker, below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25312","name":"Transplant forearm tendon","description":"Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":600.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64400","name":"Njx aa&/strd trigeminal nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24200","name":"Rmvl fb upper arm/elbw subq","description":"Removal of foreign body, upper arm or elbow area; subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27792","name":"Treatment of ankle fracture","description":"Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14040","name":"Tis trnfr f/c/c/m/n/a/g/h/f","description":"Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":467.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65273","name":"Repair of eye wound","description":"Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":229.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82600","name":"Assay of cyanide","description":"Cyanide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00813","name":"Anes upr lwr gi ndsc px","description":"Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92260","name":"Ophthalmodynamometry","description":"Ophthalmodynamometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86255","name":"Fluorescent antibody screen","description":"Fluorescent noninfectious agent antibody; screen, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77022","name":"Mri gdn parnchyma tiss abltj","description":"Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2205","name":"Manual wc accessory, handrim","description":"Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71260","name":"Ct thorax dx c+","description":"Computed tomography, thorax, diagnostic; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64732","name":"Incision of brow nerve","description":"Transection or avulsion of; supraorbital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":395.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92533","name":"Caloric vestibular test","description":"Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0250","name":"Md inr test revie inter mgmt","description":"Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of servic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68520","name":"Removal of tear sac","description":"Excision of lacrimal sac (dacryocystectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91030","name":"Acid perfusion of esophagus","description":"Esophagus, acid perfusion (bernstein) test for esophagitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0983","name":"Add pwr joystick","description":"Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q4049","name":"Finger splint, static","description":"Finger splint, static","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83861","name":"Microfluid analy tears","description":"Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15828","name":"Rhytidectomy cheek chn & nck","description":"Rhytidectomy; cheek, chin, and neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85415","name":"Fibrinolytic plasminogen","description":"Fibrinolytic factors and inhibitors; plasminogen activator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01844","name":"Anes vasc shunt/shunt revj","description":"Anesthesia for vascular shunt, or shunt revision, any type (eg, dialysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37766","name":"Phleb veins - extrem 20+","description":"Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75984","name":"Xray control catheter change","description":"Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35142","name":"Repair artery rupture thigh","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, common femoral artery (profunda femoris, superficial femoral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1717","name":"Brachytx, non-str,hdr ir-192","description":"Brachytherapy source, non-stranded, high dose rate iridium-192, per source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2360","name":"22nf nonsealed leadacid","description":"Power wheelchair accessory, 22nf non-sealed lead acid battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36620","name":"Insertion catheter artery","description":"Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0160","name":"Cerv sr wire occ/man pre ots","description":"Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75572","name":"Ct hrt w/3d image","description":"Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3d image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97535","name":"Self care mngment training","description":"Self-care/home management training (eg, activities of daily living (adl) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35092","name":"Repair artery rupture aorta","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7007","name":"Lg vol nebulizer disposable","description":"Large volume nebulizer, disposable, unfilled, used with aerosol compressor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0451","name":"Devlopment test interpt&rep","description":"Development testing, with interpretation and report, per standardized instrument form","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36478","name":"Endovenous laser 1st vein","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":534.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4490","name":"Above knee surgical stocking","description":"Surgical stockings above knee length, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27823","name":"Treatment of ankle fracture","description":"Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70486","name":"Ct maxillofacial w/o dye","description":"Computed tomography, maxillofacial area; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95990","name":"Spin/brain pump refil & main","description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64898","name":"Nrv grf mltst arm/leg >4 cm","description":"Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48552","name":"Prep donor pancreas/venous","description":"Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92583","name":"Select picture audiometry","description":"Select picture audiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53010","name":"Incision of urethra","description":"Urethrotomy or urethrostomy, external (separate procedure); perineal urethra, external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35616","name":"Bpg subclavian-axillary","description":"Bypass graft, with other than vein; subclavian-axillary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":974.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33611","name":"Repair double ventricle","description":"Repair of double outlet right ventricle with intraventricular tunnel repair;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1698.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0628","name":"Lso flex no ri stays pre ots","description":"Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefab","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78607","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27036","name":"Capsulectomy/capsulotomy hip","description":"Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone, with release of hip flexor muscles (ie, gluteus medius, gluteus minimus, tensor fascia latae, rectus femoris, sartorius, iliopsoas)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":854.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23020","name":"Capsular contracture release","description":"Capsular contracture release (eg, sever type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":581.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71111","name":"X-ray exam ribs/chest4/> vws","description":"Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00162","name":"Anes px nose&sinus rad surg","description":"Anesthesia for procedures on nose and accessory sinuses; radical surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28106","name":"Remove/graft foot lesion","description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58740","name":"Adhesiolysis tube ovary","description":"Lysis of adhesions (salpingolysis, ovariolysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51728","name":"Cystometrogram w/vp","description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53505","name":"Repair of urethra injury","description":"Urethrorrhaphy, suture of urethral wound or injury; penile","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2361","name":"22nf sealed leadacid battery","description":"Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84466","name":"Assay of transferrin","description":"Transferrin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97139","name":"Unlisted therapeutic px","description":"Unlisted therapeutic procedure (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70330","name":"X-ray exam of jaw joints","description":"Radiologic examination, temporomandibular joint, open and closed mouth; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63661","name":"Remove spine eltrd perq aray","description":"Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2014","name":"Post-d/c care plan overs 30m","description":"Limited (30 minutes) care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80190","name":"Assay of procainamide","description":"Procainamide;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50542","name":"Laparo ablate renal mass","description":"Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":943.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11444","name":"Exc face-mm b9+marg 3.1-4 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24077","name":"Rad rescj tum tiss a/e <5cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":889.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56700","name":"Prtl hymnctmy/revj hymnl rng","description":"Partial hymenectomy or revision of hymenal ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61563","name":"Excision of skull tumor","description":"Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); without optic nerve decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1816.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6219","name":"Gauze <= 16 sq in w/border","description":"Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77331","name":"Special radiation dosimetry","description":"Special dosimetry (eg, tld, microdosimetry) (specify), only when prescribed by the treating physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90814","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3002","name":"Foot insert plastazote or eq","description":"Foot, insert, removable, molded to patient model, plastazote or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32201","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":766.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53460","name":"Revision of urethra","description":"Urethromeatoplasty, with partial excision of distal urethral segment (richardson type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32663","name":"Thoracoscopy w/lobectomy","description":"Thoracoscopy, surgical; with lobectomy (single lobe)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1118.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72110","name":"X-ray exam l-2 spine 4/>vws","description":"Radiologic examination, spine, lumbosacral; minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70260","name":"X-ray exam of skull","description":"Radiologic examination, skull; complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61864","name":"Implant neuroelectrde addl","description":"Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":262.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62148","name":"Retr bone flap to fix skull","description":"Incision and retrieval of subcutaneous cranial bone graft for cranioplasty (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26605","name":"Treat metacarpal fracture","description":"Closed treatment of metacarpal fracture, single; with manipulation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":269.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0400","name":"Home sleep test/type 4 porta","description":"Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77768","name":"Hdr rdncl skn surf brachytx","description":"Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0561","name":"Humidifier nonheated w pap","description":"Humidifier, non-heated, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56405","name":"I&d vulva/perineal abscess","description":"Incision and drainage of vulva or perineal abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62303","name":"Myelography lumbar injection","description":"Myelography via lumbar injection, including radiological supervision and interpretation; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92544","name":"Optokinetic nystagmus test","description":"Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93622","name":"Comp ep eval l ventr pac&rec","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52442","name":"Cysto ins trnsprstc implt ea","description":"Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":801.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2250","name":"Remot img sub by pt, non e/m","description":"Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or p","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57065","name":"Destruction vag lesion xtnsv","description":"Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90846","name":"Family psytx w/o pt 50 min","description":"Family psychotherapy (without the patient present), 50 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81414","name":"Car ion chnnlpath inc 2 gns","description":"Cardiac ion channelopathies (eg, brugada syndrome, long qt syndrome, short qt syndrome, catecholaminergic polymorphic ventricular tachycardia); duplication/deletion gene analysis panel, must include analysis of at least 2 genes, including kcnh2 and kcnq1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29840","name":"Wrist arthroscopy","description":"Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63252","name":"Revise spine cord vsl thrlmb","description":"Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87077","name":"Culture aerobic identify","description":"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42972","name":"Control nose/throat bleeding","description":"Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); with secondary surgical intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32800","name":"Repair lung hernia","description":"Repair lung hernia through chest wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":751.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28210","name":"Repair/graft of foot tendon","description":"Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":477.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9615","name":"Urine specimen collect mult","description":"Catheterization for collection of specimen(s) (multiple patients)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54015","name":"I&d penis deep","description":"Incision and drainage of penis, deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2506","name":"Sgd prerec msg > 40 min","description":"Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63285","name":"Bx/exc idrl imed lesn cervl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89320","name":"Semen anal vol/count/mot","description":"Semen analysis; volume, count, motility, and differential","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61800","name":"Apply srs headframe add-on","description":"Application of stereotactic headframe for stereotactic radiosurgery (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1170","name":"Whlchr ampu fxd arm leg rest","description":"Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74415","name":"Urography nfs drip&/bls w/nf","description":"Urography, infusion, drip technique and/or bolus technique; with nephrotomography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88387","name":"Macroscopic xm dsj&prep tiss","description":"Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies), each tissue preparation (eg, a single lymph node)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78468","name":"Heart infarct image (ef)","description":"Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85291","name":"Clot factor xiii fibrin scrn","description":"Clotting; factor xiii (fibrin stabilizing), screen solubility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8480","name":"Pros sock single ply ak","description":"Prosthetic sock, single ply, fitting, above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43840","name":"Gstrrphy sutr duol/gstr ulcr","description":"Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49904","name":"Omental flap extra-abdom","description":"Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11424","name":"Exc h-f-nk-sp b9+marg 3.1-4","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5974","name":"Foot single axis ankle/foot","description":"All lower extremity prostheses, foot, single axis ankle/foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85675","name":"Thrombin time titer","description":"Thrombin time; titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1228","name":"Wheelchair spec sz spec ht b","description":"Special back height for wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99393","name":"Prev visit est age 5-11","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1904","name":"Afo molded ankle gauntlet","description":"Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31237","name":"Nsl/sins ndsc surg bx polypc","description":"Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0175","name":"Commode chair foot rest","description":"Foot rest, for use with commode chair, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70100","name":"X-ray exam of jaw <4views","description":"Radiologic examination, mandible; partial, less than 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29065","name":"Appl cst sho to hand lng arm","description":"Application, cast; shoulder to hand (long arm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59130","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; abdominal pregnancy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26426","name":"Repair finger/hand tendon","description":"Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); using local tissue(s), including lateral band(s), each finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":419.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29840","name":"Wrist arthroscopy","description":"Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":376.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49906","name":"Free omental flap microvasc","description":"Free omental flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6582","name":"Wrist/elbow bowden cbl dir f","description":"Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":687.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23071","name":"Exc shoulder les sc 3 cm/>","description":"Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":359.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72220","name":"X-ray exam sacrum tailbone","description":"Radiologic examination, sacrum and coccyx, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95979","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31368","name":"Partial removal of larynx","description":"Laryngectomy; subtotal supraglottic, with radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87492","name":"Chlmyd trach dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia trachomatis, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92979","name":"Endoluminl ivus oct c ea","description":"Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (list separately in addition to co","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4164","name":"Parenteral 50% dextrose solu","description":"Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4613","name":"Battery charger","description":"Battery charger; replacement for patient-owned ventilator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5535","name":"Prep bk ptb open end socket","description":"Preparatory, below knee ptb type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4483","name":"Moisture exchanger","description":"Moisture exchanger, disposable, for use with invasive mechanical ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64772","name":"Incision of spinal nerve","description":"Transection or avulsion of other spinal nerve, extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33259","name":"Ablate atria w/bypass add-on","description":"Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), with cardiopulmonary bypass (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97113","name":"Aquatic therapy/exercises","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76514","name":"Echo exam of eye thickness","description":"Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78130","name":"Red cell survival study","description":"Red cell survival study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5614","name":"4-bar link above knee w/swng","description":"Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4362","name":"Solid skin barrier","description":"Skin barrier; solid, 4 x 4 or equivalent; each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21811","name":"Optx of rib fx w/fixj scope","description":"Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75741","name":"Artery x-rays lung","description":"Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50542","name":"Laparo ablate renal mass","description":"Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86757","name":"Rickettsia antibody","description":"Antibody; rickettsia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6214","name":"Foam drg > 48 sq in w/border","description":"Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72147","name":"Mri chest spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15931","name":"Exc sacral pr ulc prim sutr","description":"Excision, sacral pressure ulcer, with primary suture;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":460.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00928","name":"Anes male gent rad orch abd","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); radical orchiectomy, abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0312","name":"Immunize couns < 21yr 5-15 m","description":"Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45350","name":"Sgmdsc w/band ligation","description":"Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64859","name":"Nerve surgery","description":"Suture of each additional major peripheral nerve (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33476","name":"Revision of heart chamber","description":"Right ventricular resection for infundibular stenosis, with or without commissurotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50783","name":"Reimplant ureter in bladder","description":"Ureteroneocystostomy; with extensive ureteral tailoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":911.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27327","name":"Exc thigh/knee les sc < 3 cm","description":"Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36512","name":"Apheresis rbc","description":"Therapeutic apheresis; for red blood cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11000","name":"Dbrdmt ecz/infected skin<10%","description":"Debridement of extensive eczematous or infected skin; up to 10% of body surface","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60600","name":"Remove carotid body lesion","description":"Excision of carotid body tumor; without excision of carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1185.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84234","name":"Assay of progesterone","description":"Receptor assay; progesterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37780","name":"Revision of leg vein","description":"Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50320","name":"Remove kidney living donor","description":"Donor nephrectomy (including cold preservation); open, from living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2000","name":"Kafo sing fre stirr thi/calf","description":"Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar ak orthosis), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":533.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84445","name":"Assay of tsi globulin","description":"Thyroid stimulating immune globulins (tsi)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95922","name":"Autonomic nrv adrenrg inervj","description":"Testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and r-r interval changes during valsalva maneuver and at least 5 minutes of passive tilt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64861","name":"Repair of arm nerves","description":"Suture of; brachial plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1380.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35840","name":"Explore abdominal vessels","description":"Exploration for postoperative hemorrhage, thrombosis or infection; abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64650","name":"Chemodenerv eccrine glands","description":"Chemodenervation of eccrine glands; both axillae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95146","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 2 single stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25066","name":"Biopsy forearm soft tissues","description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":298.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0871","name":"Pwc gp 4 vhd seat/back","description":"Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36512","name":"Apheresis rbc","description":"Therapeutic apheresis; for red blood cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1353","name":"Oxygen supplies regulator","description":"Regulator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2082","name":"Visit esketamine 56m or less","description":"Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8999","name":"Resuscitation bag","description":"Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54150","name":"Circumcision w/regionl block","description":"Circumcision, using clamp or other device with regional dorsal penile or ring block","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33416","name":"Revise ventricle muscle","description":"Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis (eg, asymmetric septal hypertrophy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42821","name":"Remove tonsils and adenoids","description":"Tonsillectomy and adenoidectomy; age 12 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43825","name":"Gastrojejunostomy w/vagotomy","description":"Gastrojejunostomy; with vagotomy, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54240","name":"Penile plethysmography","description":"Penile plethysmography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62192","name":"Establish brain cavity shunt","description":"Creation of shunt; subarachnoid/subdural-peritoneal, -pleural, other terminus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":887.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45910","name":"Dilation of rectal narrowing","description":"Dilation of rectal stricture (separate procedure) under anesthesia other than local","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82952","name":"Gtt-added samples","description":"Glucose; tolerance test, each additional beyond 3 specimens (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0118","name":"Glaucoma scrn hgh risk direc","description":"Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01340","name":"Anes clsd px lower 1/3 femur","description":"Anesthesia for all closed procedures on lower one-third of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78215","name":"Lvr&spleen img static only","description":"Liver and spleen imaging; static only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44700","name":"Suspend bowel w/prosthesis","description":"Exclusion of small intestine from pelvis by mesh or other prosthesis, or native tissue (eg, bladder or omentum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82465","name":"Assay bld/serum cholesterol","description":"Cholesterol, serum or whole blood, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00140","name":"Anes procedures on eye nos","description":"Anesthesia for procedures on eye; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43227","name":"Esophagoscopy control bleed","description":"Esophagoscopy, flexible, transoral; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51040","name":"Incise & drain bladder","description":"Cystostomy, cystotomy with drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0448T","name":"Remvl insj impltbl gluc sens","description":"Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1529.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94400","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60252","name":"Removal of thyroid","description":"Thyroidectomy, total or subtotal for malignancy; with limited neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1116.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36224","name":"Place cath carotd art","description":"Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93456","name":"R hrt coronary artery angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1162.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15775","name":"Hair trnspl 1-15 punch grfts","description":"Punch graft for hair transplant; 1 to 15 punch grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91132","name":"Electrogastrography","description":"Electrogastrography, diagnostic, transcutaneous;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":239.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74290","name":"Contrast x-ray gallbladder","description":"Cholecystography, oral contrast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53020","name":"Incision of urethra","description":"Meatotomy, cutting of meatus (separate procedure); except infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00532","name":"Anes access ctr venous crcj","description":"Anesthesia for access to central venous circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94004","name":"Vent mgmt nf per day","description":"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; nursing facility, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77334","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82150","name":"Assay of amylase","description":"Amylase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63057","name":"Decompress spine cord add-on","description":"Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26561","name":"Repair of web finger","description":"Repair of syndactyly (web finger) each web space; with skin flaps and grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38204","name":"Bl donor search management","description":"Management of recipient hematopoietic progenitor cell donor search and cell acquisition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6456","name":"Zinc paste band w >=3in<5in/yd","description":"Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27848","name":"Treat ankle dislocation","description":"Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; with repair or internal or external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49327","name":"Lap ins device for rt","description":"Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (list separately in addition to code for primary proced","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82664","name":"Electrophoretic test","description":"Electrophoretic technique, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2207","name":"Lens sphcy bifocal 4.25-7d/.","description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31205","name":"Removal of ethmoid sinus","description":"Ethmoidectomy; extranasal, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20100","name":"Expl pentrg wound neck","description":"Exploration of penetrating wound (separate procedure); neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":514.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35188","name":"Rpr acq av fistula head&neck","description":"Repair, acquired or traumatic arteriovenous fistula; head and neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88147","name":"Cytopath c/v automated","description":"Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93603","name":"Right ventricular recording","description":"Right ventricular recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96420","name":"Chemo ia push tecnique","description":"Chemotherapy administration, intra-arterial; push technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00848","name":"Anes iper px pel exentration","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; pelvic exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24140","name":"Partial exc bone humerus","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97034","name":"App mdlty 1+cntrst bth ea 15","description":"Application of a modality to 1 or more areas; contrast baths, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43116","name":"Partial removal of esophagus","description":"Partial esophagectomy, cervical, with free intestinal graft, including microvascular anastomosis, obtaining the graft and intestinal reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4180.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26030","name":"Drainage of palm bursas","description":"Drainage of palmar bursa; multiple bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4320","name":"Irrigation tray","description":"Irrigation tray with bulb or piston syringe, any purpose","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82985","name":"Assay of glycated protein","description":"Glycated protein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60270","name":"Removal of thyroid","description":"Thyroidectomy, including substernal thyroid; sternal split or transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43605","name":"Biopsy of stomach","description":"Biopsy of stomach, by laparotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":699.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97039","name":"Unlisted modality","description":"Unlisted modality (specify type and time if constant attendance)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00906","name":"Anes vulvectomy","description":"Anesthesia for; vulvectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26040","name":"Release palm contracture","description":"Fasciotomy, palmar (eg, dupuytrens contracture); percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88283","name":"Chromosome banding study","description":"Chromosome analysis; additional specialized banding technique (eg, nor, c-banding)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90801","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP18","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2309","name":"Lens sphc trifocal 4.25-7/4.","description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26516","name":"Fusion of knuckle joint","description":"Capsulodesis, metacarpophalangeal joint; single digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":594.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0080","name":"Care manag h vst new pt 75 m","description":"Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56800","name":"Plastic repair introitus","description":"Plastic repair of introitus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0480","name":"Percussor elect/pneum home m","description":"Percussor, electric or pneumatic, home model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82108","name":"Assay of aluminum","description":"Aluminum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28320","name":"Repair of foot bones","description":"Repair, nonunion or malunion; tarsal bones","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":502.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43325","name":"Revise esophagus & stomach","description":"Esophagogastric fundoplasty, with fundic patch (thal-nissen procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78201","name":"Liver imaging static only","description":"Liver imaging; static only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36575","name":"Repair tunneled cv cath","description":"Repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump, central or peripheral insertion site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50825","name":"Construct bowel bladder","description":"Continent diversion, including intestine anastomosis using any segment of small and/or large intestine (kock pouch or camey enterocystoplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1346.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82540","name":"Assay of creatine","description":"Creatine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44901","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":807.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86677","name":"Helicobacter pylori antibody","description":"Antibody; helicobacter pylori","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92998","name":"Pul art balloon repr percut","description":"Percutaneous transluminal pulmonary artery balloon angioplasty; each additional vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":345.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0449T","name":"Insj aqueous drain dev 1st","description":"Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43270","name":"Egd lesion ablation","description":"Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":549.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00546","name":"Anes thrcm px pulm rescj","description":"Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); pulmonary resection with thoracoplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59614","name":"Vbac care after delivery","description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1017.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25031","name":"I&d forearm&/wrist bursa","description":"Incision and drainage, forearm and/or wrist; bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33730","name":"Repair heart-vein defect(s)","description":"Complete repair of anomalous pulmonary venous return (supracardiac, intracardiac, or infracardiac types)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1743.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93010","name":"Electrocardiogram report","description":"Electrocardiogram, routine ecg with at least 12 leads; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57513","name":"Laser surgery of cervix","description":"Cautery of cervix; laser ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24073","name":"Ex arm/elbow tum deep 5 cm/>","description":"Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92548","name":"Cdp-sot 6 cond w/i&r","description":"Computerized dynamic posturography sensory organization test (cdp-sot), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99156","name":"Mod sed oth phys/qhp 5/>yrs","description":"Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 year","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23156","name":"Removal of humerus lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":572.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71250","name":"Ct thorax dx c-","description":"Computed tomography, thorax, diagnostic; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84402","name":"Assay of free testosterone","description":"Testosterone; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42426","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1055.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82205","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0005","name":"Alcohol and/or drug services","description":"Alcohol and/or drug services; group counseling by a clinician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7045","name":"Pediatric electric hook","description":"Electric hook, switch or myoelectric controlled, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":802.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26418","name":"Repair finger tendon","description":"Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":490.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95076","name":"Ingest challenge ini 120 min","description":"Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); initial 120 minutes of testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83012","name":"Assay of haptoglobins","description":"Haptoglobin; phenotypes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35656","name":"Bpg femoral-popliteal","description":"Bypass graft, with other than vein; femoral-popliteal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28011","name":"Incision of toe tendons","description":"Tenotomy, percutaneous, toe; multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0861","name":"Halo repl liner/interface","description":"Addition to halo procedure, replacement liner/interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84144","name":"Assay of progesterone","description":"Progesterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23615","name":"Optx prox humrl fx w/int fix","description":"Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":744.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50574","name":"Kidney endoscopy & biopsy","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6625","name":"Rotation wrst w/ cable lock","description":"Upper extremity addition, rotation wrist unit with cable lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57180","name":"Treat vaginal bleeding","description":"Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38230","name":"Bone marrow harvest allogen","description":"Bone marrow harvesting for transplantation; allogeneic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31380","name":"Partial removal of larynx","description":"Partial laryngectomy (hemilaryngectomy); anterovertical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1444.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2210","name":"Dorsiflexion assist each joi","description":"Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2134","name":"Kafo fem fx cast semi-rigid","description":"Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":600.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62370","name":"Anl sp inf pmp w/mdreprg&fil","description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill of a physician or other qualified health care professional)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0248","name":"Hdtrans bench w/wo comm open","description":"Transfer bench, heavy duty, for tub or toilet with or without commode opening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42180","name":"Repair lac palate<2 cm","description":"Repair, laceration of palate; up to 2 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5999","name":"Lowr extremity prosthes nos","description":"Lower extremity prosthesis, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6228","name":"Gauze <= 16 sq in water/sal","description":"Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63281","name":"Bx/exc idrl spine lesn thrc","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86778","name":"Toxoplasma antibody igm","description":"Antibody; toxoplasma, igm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59430","name":"Care after delivery","description":"Postpartum care only (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80048","name":"Basic metabolic pnl total ca","description":"Basic metabolic panel (calcium, total) this panel must include the following: calcium, total (82310) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) potassium (84132) sodium (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92584","name":"Electrocochleography","description":"Electrocochleography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32650","name":"Thoracoscopy w/pleurodesis","description":"Thoracoscopy, surgical; with pleurodesis (eg, mechanical or chemical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70491","name":"Ct soft tissue neck w/dye","description":"Computed tomography, soft tissue neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94761","name":"N-invas ear/pls oximetry mlt","description":"Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01486","name":"Anes open total ankle rplcmt","description":"Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26476","name":"Tendon lengthening","description":"Lengthening of tendon, extensor, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42425","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":651.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77085","name":"Dxa bone density axl vrt fx","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32652","name":"Thoracoscopy rem totl cortex","description":"Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1328.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67415","name":"Aspiration orbital contents","description":"Fine needle aspiration of orbital contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21209","name":"Reduction of facial bones","description":"Osteoplasty, facial bones; reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":644.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0487","name":"Leads any type vad, rep only","description":"Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2341","name":"W/c wdth 24-27 in seat frame","description":"Power wheelchair accessory, nonstandard seat frame width, 24-27 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84307","name":"Assay of somatostatin","description":"Somatostatin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27695","name":"Repair of ankle ligament","description":"Repair, primary, disrupted ligament, ankle; collateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61210","name":"Burr hole implt ventr cath","description":"Burr hole(s); for implanting ventricular catheter, reservoir, eeg electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01962","name":"Anes urgent hysterectomy","description":"Anesthesia for urgent hysterectomy following delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91000","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01840","name":"Anes art f/arm wrst&hnd nos","description":"Anesthesia for procedures on arteries of forearm, wrist, and hand; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4404","name":"Ostomy ring each","description":"Ostomy ring, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22808","name":"Arthrd ant dfrm 2-3 vrt sgm","description":"Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88166","name":"Cytopath tbs c/v auto redo","description":"Cytopathology, slides, cervical or vaginal (the bethesda system); with manual screening and computer-assisted rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0213T","name":"Njx paravert w/us cer/thor","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12053","name":"Intmd rpr face/mm 5.1-7.5 cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":221.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00930","name":"Anes px male gent orchiopexy","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); orchiopexy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24410","name":"Mlt osteot rlgnm imed rd hum","description":"Multiple osteotomies with realignment on intramedullary rod, humeral shaft (sofield type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":894.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44227","name":"Lap close enterostomy","description":"Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1372.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63066","name":"Decompress spine cord add-on","description":"Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00796","name":"Anes iper upr abd lvr trnspl","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; liver transplant (recipient)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73565","name":"X-ray exam of knees","description":"Radiologic examination, knee; both knees, standing, anteroposterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0047","name":"Alcohol/drug abuse svc nos","description":"Alcohol and/or other drug abuse services, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2134","name":"Kafo fem fx cast semi-rigid","description":"Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70220","name":"X-ray exam of sinuses","description":"Radiologic examination, sinuses, paranasal, complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01714","name":"Anes nrv msc upr a&e tnplsty","description":"Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenoplasty, elbow to shoulder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75574","name":"Ct angio hrt w/3d image","description":"Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3d image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0483","name":"Hi freq chest wall oscil sys","description":"High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26500","name":"Hand tendon reconstruction","description":"Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50065","name":"Nl sec surg operj calculus","description":"Nephrolithotomy; secondary surgical operation for calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":977.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43880","name":"Closure gastrocolic fistula","description":"Closure of gastrocolic fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36573","name":"Insj picc rs&i 5 yr+","description":"Insertion of peripherally inserted central venous catheter (picc), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25365","name":"Revise radius & ulna","description":"Osteotomy; radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46601","name":"Diagnostic anoscopy","description":"Anoscopy; diagnostic, with high-resolution magnification (hra) (eg, colposcope, operating microscope) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58100","name":"Biopsy of uterus lining","description":"Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2750","name":"Anti-reflective coating","description":"Anti-reflective coating, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76000","name":"Fluoroscopy <1 hr phys/qhp","description":"Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28755","name":"Fusion of big toe joint","description":"Arthrodesis, great toe; interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":414.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68335","name":"Revise/graft eyelid lining","description":"Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50574","name":"Kidney endoscopy & biopsy","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33545","name":"Repair of heart damage","description":"Repair of postinfarction ventricular septal defect, with or without myocardial resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23675","name":"Cltx sho dislc neck fx mnpj","description":"Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62311","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15610","name":"Delay flap arms/legs","description":"Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":227.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31615","name":"Trcheobrnchsc est trachs inc","description":"Tracheobronchoscopy through established tracheostomy incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7364","name":"Twelve volt battery utah/equ","description":"Twelve volt battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87517","name":"Hepatitis b dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis b virus, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23031","name":"I&d shoulder infected bursa","description":"Incision and drainage, shoulder area; infected bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":331.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00918","name":"Anes trurl px urtrl cal rmvl","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); with fragmentation, manipulation and/or removal of ureteral calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33883","name":"Delayed plmt prox xtn prosth","description":"Delayed placement of proximal extension prosthesis(es) not involving coverage of the left subclavian artery origin, after endovascular repair of the thoracic aorta, including pre-procedure sizing and device selection, nonselective catheterization(s), all associated radiological supervision and inter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7360","name":"Six volt bat otto bock/eq ea","description":"Six volt battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99465","name":"Nb resuscitation","description":"Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99243","name":"Off/op cnsltj new/est low 30","description":"Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0655","name":"Pneumatic appliance half arm","description":"Non-segmental pneumatic appliance for use with pneumatic compressor, half arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88341","name":"Imhchem/imcytchm ea add antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25135","name":"Remove & graft wrist lesion","description":"Excision or curettage of bone cyst or benign tumor of carpal bones; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40810","name":"Excision of mouth lesion","description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":162.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44378","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":294.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93508","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1064.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71550","name":"Mri chest w/o dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28270","name":"Release of foot contracture","description":"Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53447","name":"Remove/replace ur sphincter","description":"Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":654.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q9955","name":"Inj perflexane lip micros,ml","description":"Injection, perflexane lipid microspheres, per ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92990","name":"Revision of pulmonary valve","description":"Percutaneous balloon valvuloplasty; pulmonary valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1157.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86336","name":"Inhibin a","description":"Inhibin a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0479T","name":"Fxjl abl lsr 1st 100 sq cm","description":"Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or part thereof, or 1% of body surface area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80164","name":"Assay dipropylacetic acd tot","description":"Valproic acid (dipropylacetic acid); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11462","name":"Exc skn hdrdnt ing smpl/ntrm","description":"Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00797","name":"Anes iper upr abd gstr px mo","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7001","name":"Nondisposable pump canister","description":"Canister, non-disposable, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82438","name":"Assay other fluid chlorides","description":"Chloride; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95870","name":"Ndl emg lmtd std musc 1 xtr","description":"Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78579","name":"Lung ventilation imaging","description":"Pulmonary ventilation imaging (eg, aerosol or gas)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58210","name":"Extensive hysterectomy","description":"Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1159.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93229","name":"Remote 30 day ecg tech supp","description":"External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ecg data storage (retrievable with query) with ecg triggered and patient selected events transmitted to a remote attended surveillance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87450","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7499","name":"Upper extremity prosthes nos","description":"Upper extremity prosthesis, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11200","name":"Rmvl skin tags up to&inc 15","description":"Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73630","name":"X-ray exam of foot","description":"Radiologic examination, foot; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11305","name":"Shave skin lesion 0.5 cm/<","description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2508","name":"Sgd spelling phys contact","description":"Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22554","name":"Arthrd ant ntrbd min dsc crv","description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below c2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30300","name":"Remove nasal foreign body","description":"Removal foreign body, intranasal; office type procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31365","name":"Removal of larynx","description":"Laryngectomy; total, with radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43415","name":"Repair esophagus wound","description":"Suture of esophageal wound or injury; transthoracic or transabdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2133.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29822","name":"Sho arthrs srg lmtd dbrdmt","description":"Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99304","name":"1st nf care sf/low mdm 25","description":"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. when using total time on the date of the encounter for code selection, 25 minutes mus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93455","name":"Coronary art/grft angio s&i","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injecti","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92650","name":"Aep scr auditory potential","description":"Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92538","name":"Caloric vstblr test w/rec","description":"Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0200","name":"Heat lamp without stand","description":"Heat lamp, without stand (table model), includes bulb, or infrared element","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33824","name":"Repair pda div 18 yrs&older","description":"Repair of patent ductus arteriosus; by division, 18 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1022.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32491","name":"Lung volume reduction","description":"Removal of lung, other than pneumonectomy; with resection-plication of emphysematous lung(s) (bullous or non-bullous) for lung volume reduction, sternal split or transthoracic approach, includes any pleural procedure, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89325","name":"Sperm antibody test","description":"Sperm antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64646","name":"Chemodenerv trunk musc 1-5","description":"Chemodenervation of trunk muscle(s); 1-5 muscle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95719","name":"Eeg phys/qhp ea incr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of eeg recording, interpretation and report after each 24-hour period; w","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23465","name":"Repair shoulder capsule","description":"Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":947.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15330","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36014","name":"Place catheter in artery","description":"Selective catheter placement, left or right pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":676.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82759","name":"Assay of rbc galactokinase","description":"Galactokinase, rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32140","name":"Removal of lung lesion(s)","description":"Thoracotomy; with cyst(s) removal, includes pleural procedure when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94777","name":"Ped home apnea mntr rvw i&r","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; review, interpretation and preparation of report only by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63744","name":"Revision of spinal shunt","description":"Replacement, irrigation or revision of lumbosubarachnoid shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":610.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25085","name":"Incision of wrist capsule","description":"Capsulotomy, wrist (eg, contracture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33010","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82272","name":"Occult bld feces 1-3 tests","description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35551","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1540.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99392","name":"Prev visit est age 1-4","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50593","name":"Perc cryo ablate renal tum","description":"Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3498.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75605","name":"Contrast exam thoracic aorta","description":"Aortography, thoracic, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95251","name":"Cont gluc mntr analysis i&r","description":"Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99460","name":"Init nb em per day hosp","description":"Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42200","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate, soft and/or hard palate only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":752.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0984","name":"Protect body sock ea pre ots","description":"Protective body sock, prefabricated, off-the-shelf, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20805","name":"Replant forearm complete","description":"Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2782.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15740","name":"Island pedicle flap graft","description":"Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":626.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54125","name":"Removal of penis","description":"Amputation of penis; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26055","name":"Incise finger tendon sheath","description":"Tendon sheath incision (eg, for trigger finger)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":448.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23120","name":"Claviculectomy partial","description":"Claviculectomy; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50740","name":"Fusion of ureter & kidney","description":"Ureteropyelostomy, anastomosis of ureter and renal pelvis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1073.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99310","name":"Sbsq nf care high mdm 45","description":"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 45 minutes must be met or exc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93015","name":"Cv stress test supvj i&r","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65920","name":"Remove implant of eye","description":"Removal of implanted material, anterior segment of eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0191","name":"Protector heel or elbow","description":"Heel or elbow protector, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17311","name":"Mohs 1 stage h/n/hf/g","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), h","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":406.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57260","name":"Cmbn ant pst colprhy","description":"Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":494.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82696","name":"Assay of etiocholanolone","description":"Etiocholanolone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52500","name":"Trurl resection bladder neck","description":"Transurethral resection of bladder neck (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":395.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43250","name":"Egd cautery tumor polyp","description":"Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24066","name":"Biopsy arm/elbow soft tissue","description":"Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":519.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46730","name":"Construction of absent anus","description":"Repair of high imperforate anus without fistula; perineal or sacroperineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0609","name":"Repl electrode for aed","description":"Replacement electrodes for use with automated external defibrillator, garment type only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3530","name":"Ortho shoe add half sole","description":"Orthopedic shoe addition, sole, half","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65778","name":"Cover eye w/membrane","description":"Placement of amniotic membrane on the ocular surface; without sutures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67938","name":"Remove eyelid foreign body","description":"Removal of embedded foreign body, eyelid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6213","name":"Foam drg >16<=48 sq in w/bdr","description":"Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5617","name":"Ak/bk self-aligning unit ea","description":"Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4363","name":"Ostomy clamp, replacement","description":"Ostomy clamp, any type, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22902","name":"Exc abd les sc < 3 cm","description":"Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69605","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1261.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26490","name":"Revise thumb tendon","description":"Opponensplasty; superficialis tendon transfer type, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27840","name":"Treat ankle dislocation","description":"Closed treatment of ankle dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72020","name":"X-ray exam of spine 1 view","description":"Radiologic examination, spine, single view, specify level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92982","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":572.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56620","name":"Vulvectomy simple partial","description":"Vulvectomy simple; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27265","name":"Treat hip dislocation","description":"Closed treatment of post hip arthroplasty dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93609","name":"Intra-vntr mapg tchycar site","description":"Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0407","name":"Inpt/tele follow up 25","description":"Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82384","name":"Assay three catecholamines","description":"Catecholamines; fractionated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78591","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0389","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L1901","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27536","name":"Treat knee fracture","description":"Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77333","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28122","name":"Partial removal of foot bone","description":"Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35560","name":"Art byp grft aortorenal","description":"Bypass graft, with vein; aortorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1506.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44141","name":"Partial removal of colon","description":"Colectomy, partial; with skin level cecostomy or colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1509.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35321","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; axillary-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":784.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4452","name":"Waterproof tape","description":"Tape, waterproof, per 18 square inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["AW","GT","GQ","95","AU","AV","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45332","name":"Sigmoidoscopy w/fb removal","description":"Sigmoidoscopy, flexible; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4349","name":"Disposable male external cat","description":"Male external catheter, with or without adhesive, disposable, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21127","name":"Augmentation mndblr b1 grf","description":"Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94760","name":"N-invas ear/pls oximetry 1","description":"Noninvasive ear or pulse oximetry for oxygen saturation; single determination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64716","name":"Revision of cranial nerve","description":"Neuroplasty and/or transposition; cranial nerve (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":426.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85041","name":"Automated rbc count","description":"Blood count; red blood cell (rbc), automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1841","name":"Sps/pass shoulder device","description":"Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54512","name":"Excise lesion testis","description":"Excision of extraparenchymal lesion of testis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01202","name":"Anes arthroscopic px hip jt","description":"Anesthesia for arthroscopic procedures of hip joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80436","name":"Metyrapone panel","description":"Metyrapone panel this panel must include the following: cortisol (82533 x 2) 11 deoxycortisol (82634 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9484","name":"Remote e/m new pt 45mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5698","name":"Ak/knee disartic silesian ba","description":"Addition to lower extremity, above knee or knee disarticulation, silesian bandage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15100","name":"Splt agrft t/a/l 1st 100sqcm","description":"Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34830","name":"Open aortic tube prosth repr","description":"Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22612","name":"Arthrd pst tq 1ntrspc lumbar","description":"Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50694","name":"Plmt ureteral stent prq","description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":930.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92596","name":"Ear protector evaluation","description":"Ear protector attenuation measurements","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26373","name":"Repair finger/hand tendon","description":"Repair or advancement of profundus tendon, with intact superficialis tendon; secondary without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21280","name":"Medial canthopexy","description":"Medial canthopexy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81177","name":"Atn1 gene detc abnor alleles","description":"Atn1 (atrophin 1) (eg, dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85240","name":"Clot factor viii ahg 1 stage","description":"Clotting; factor viii (ahg), 1-stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43233","name":"Egd balloon dil esoph30 mm/>","description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0423","name":"Intens cardiac rehab no exer","description":"Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68505","name":"Partial removal tear gland","description":"Excision of lacrimal gland (dacryoadenectomy), except for tumor; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4168","name":"Parenteral sol amino acid 3.","description":"Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72070","name":"X-ray exam thorac spine 2vws","description":"Radiologic examination, spine; thoracic, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55110","name":"Explore scrotum","description":"Scrotal exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71110","name":"X-ray exam ribs bil 3 views","description":"Radiologic examination, ribs, bilateral; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93975","name":"Vascular study","description":"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27634","name":"Exc leg/ankle tum dep 5 cm/>","description":"Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94726","name":"Plethysmography lung volumes","description":"Plethysmography for determination of lung volumes and, when performed, airway resistance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85230","name":"Clot factor vii proconvertin","description":"Clotting; factor vii (proconvertin, stable factor)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87070","name":"Culture othr specimn aerobic","description":"Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92313","name":"C-lens fitg corneosclrl lens","description":"Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72149","name":"Mri lumbar spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27695","name":"Repair of ankle ligament","description":"Repair, primary, disrupted ligament, ankle; collateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":389.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25230","name":"Partial removal of radius","description":"Radial styloidectomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31573","name":"Largsc w/ther injection","description":"Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50920","name":"Closure ureter/skin fistula","description":"Closure of ureterocutaneous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27756","name":"Treatment of tibia fracture","description":"Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins or screws)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":482.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2310","name":"Abduction bar-straight","description":"Addition to lower extremity, abduction bar-straight","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77750","name":"Infuse radioactive materials","description":"Infusion or instillation of radioelement solution (includes 3-month follow-up care)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0236","name":"Pump for water circulating p","description":"Pump for water circulating pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37718","name":"Lig div&strpg short saph vn","description":"Ligation, division, and stripping, short saphenous vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53270","name":"Removal of urethra gland","description":"Excision or fulguration; skenes glands","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0311","name":"Immunize counsel 16-30 mins","description":"Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service,  16-30 mins time (this code is used for medicaid billing purposes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33840","name":"Exc coa w/direct anastomosis","description":"Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00103","name":"Anes rcnstv px eyelid","description":"Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13102","name":"Cmplx rpr trunk addl 5cm/<","description":"Repair, complex, trunk; each additional 5 cm or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54800","name":"Biopsy of epididymis","description":"Biopsy of epididymis, needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88120","name":"Cytp urne 3-5 probes ea spec","description":"Cytopathology, in situ hybridization (eg, fish), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86826","name":"Hla x-match noncytotoxc addl","description":"Human leukocyte antigen (hla) crossmatch, non-cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0507T","name":"Near ifr 2img mibmn glnd i&r","description":"Near infrared dual imaging (ie, simultaneous reflective and transilluminated light) of meibomian glands, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58674","name":"Laps abltj uterine fibroids","description":"Laparoscopy, surgical, ablation of uterine fibroid(s) including intraoperative ultrasound guidance and monitoring, radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":523.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78579","name":"Lung ventilation imaging","description":"Pulmonary ventilation imaging (eg, aerosol or gas)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21932","name":"Exc back tum deep < 5 cm","description":"Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":568.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01650","name":"Anes art sho&ax nos","description":"Anesthesia for procedures on arteries of shoulder and axilla; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64857","name":"Repair arm/leg nerve","description":"Suture of major peripheral nerve, arm or leg, except sciatic; without transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44213","name":"Lap mobil splenic fl add-on","description":"Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99478","name":"Sbsq ic vlbw inf<1,500 gm","description":"Subsequent intensive care, per day, for the evaluation and management of the recovering very low birth weight infant (present body weight less than 1,500 grams)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00550","name":"Anes for sternal debridement","description":"Anesthesia for sternal debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86687","name":"Htlv-i antibody","description":"Antibody; htlv-i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4765","name":"Dialysate conc pow per pack","description":"Dialysate concentrate, powder, additive for peritoneal dialysis, per packet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58615","name":"Occlude fallopian tube(s)","description":"Occlusion of fallopian tube(s) by device (eg, band, clip, falope ring) vaginal or suprapubic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85415","name":"Fibrinolytic plasminogen","description":"Fibrinolytic factors and inhibitors; plasminogen activator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21705","name":"Revision of neck muscle/rib","description":"Division of scalenus anticus; with resection of cervical rib","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":470.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81274","name":"Htt gene charac alleles","description":"Htt (huntingtin) (eg, huntington disease) gene analysis; characterization of alleles (eg, expanded size)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4709","name":"Acid conc sol per gallon","description":"Acid concentrate, solution, for hemodialysis, per gallon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7044","name":"Pap oral interface","description":"Oral interface used with positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22845","name":"Insert spine fixation device","description":"Anterior instrumentation; 2 to 3 vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78111","name":"Plasma volume multiple","description":"Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50500","name":"Repair of kidney wound","description":"Nephrorrhaphy, suture of kidney wound or injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1055.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52260","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5610","name":"Above knee hydracadence","description":"Addition to lower extremity, endoskeletal system, above knee, hydracadence system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1027.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25115","name":"Remove wrist/forearm lesion","description":"Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, tbc, or other granulomas, rheumatoid arthritis); flexors","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":632.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87900","name":"Phenotype infect agent drug","description":"Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37212","name":"Thrombolytic venous therapy","description":"Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1234","name":"Fld ped wc tltnspc w/o seat","description":"Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7039","name":"Filter, non disposable w pap","description":"Filter, non disposable, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97533","name":"Sensory integration","description":"Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32601","name":"Thoracoscopy diagnostic","description":"Thoracoscopy, diagnostic (separate procedure); lungs, pericardial sac, mediastinal or pleural space, without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32609","name":"Thoracoscopy w/bx pleura","description":"Thoracoscopy; with biopsy(ies) of pleura","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87880","name":"Strep a assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; streptococcus, group a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59830","name":"Treat uterus infection","description":"Treatment of septic abortion, completed surgically","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":398.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26750","name":"Treat finger fracture each","description":"Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82977","name":"Assay of ggt","description":"Glutamyltransferase, gamma (ggt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47141","name":"Partial removal donor liver","description":"Donor hepatectomy (including cold preservation), from living donor; total left lobectomy (segments ii, iii and iv)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3592.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85732","name":"Thromboplastin time partial","description":"Thromboplastin time, partial (ptt); substitution, plasma fractions, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58400","name":"Suspension of uterus","description":"Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43205","name":"Esophagus endoscopy/ligation","description":"Esophagoscopy, flexible, transoral; with band ligation of esophageal varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92586","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0600","name":"Suction pump portab hom modl","description":"Respiratory suction pump, home model, portable or stationary, electric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83901","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83655","name":"Assay of lead","description":"Lead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80415","name":"Tot estradiol response panel","description":"Chorionic gonadotropin stimulation panel; estradiol response this panel must include the following: estradiol, total (82670 x 2 on 3 pooled blood samples)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86903","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42450","name":"Excise sublingual gland","description":"Excision of sublingual gland","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47780","name":"Fuse bile ducts and bowel","description":"Anastomosis, roux-en-y, of extrahepatic biliary ducts and gastrointestinal tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35536","name":"Art byp grft splenorenal","description":"Bypass graft, with vein; splenorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1494.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27140","name":"Transplant femur ridge","description":"Osteotomy and transfer of greater trochanter of femur (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27538","name":"Treat knee fracture(s)","description":"Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84480","name":"Assay triiodothyronine (t3)","description":"Triiodothyronine t3; total (tt-3)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0160","name":"Cerv sr wire occ/man pre ots","description":"Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93229","name":"Remote 30 day ecg tech supp","description":"External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ecg data storage (retrievable with query) with ecg triggered and patient selected events transmitted to a remote attended surveillance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82271","name":"Occult blood other sources","description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2209","name":"Lens sphcy bifocal 4.25-7/4.","description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29836","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; synovectomy, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":490.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44660","name":"Repair bowel-bladder fistula","description":"Closure of enterovesical fistula; without intestinal or bladder resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1072.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8610","name":"Ocular implant","description":"Ocular implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20957","name":"Mt bone graft microvasc","description":"Bone graft with microvascular anastomosis; metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2337.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61684","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; infratentorial, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2621.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67820","name":"Revise eyelashes","description":"Correction of trichiasis; epilation, by forceps only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70328","name":"X-ray exam of jaw joint","description":"Radiologic examination, temporomandibular joint, open and closed mouth; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3677","name":"So hard plas stabili pre cst","description":"Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74248","name":"X-ray sm int f-thru std","description":"Radiologic small intestine follow-through study, including multiple serial images (list separately in addition to code for primary procedure for upper gi radiologic examination)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80198","name":"Assay of theophylline","description":"Theophylline","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31656","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":259.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7010","name":"Disposable corrugated tubing","description":"Corrugated tubing, disposable, used with large volume nebulizer, 100 feet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0700","name":"Safety equipment","description":"Safety equipment, device or accessory, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2810","name":"Knee control condylar pad","description":"Addition to lower extremity orthosis, knee control, condylar pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20690","name":"Appl unipln uni ext fixj sys","description":"Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99324","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29505","name":"Application long leg splint","description":"Application of long leg splint (thigh to ankle or toes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0648","name":"Lso sag r an/pos pnl pre ots","description":"Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":501.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2118","name":"Lens aniseikonic single","description":"Aniseikonic lens, single vision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27253","name":"Treat hip dislocation","description":"Open treatment of hip dislocation, traumatic, without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4193","name":"Parenteral sol 52-73 gm prot","description":"Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19260","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":763.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1930","name":"Afo plastic","description":"Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21070","name":"Remove coronoid process","description":"Coronoidectomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99305","name":"1st nf care moderate mdm 35","description":"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 35 minutes must be met or ex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3917","name":"Metacarp fx orthosis pre cst","description":"Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37186","name":"Sec art thrombectomy add-on","description":"Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":663.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45126","name":"Pelvic exenteration","description":"Pelvic exenteration for colorectal malignancy, with proctectomy (with or without colostomy), with removal of bladder and ureteral transplantations, and/or hysterectomy, or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), or any combination thereof","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2204.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25900","name":"Amputation of forearm","description":"Amputation, forearm, through radius and ulna;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83857","name":"Assay of methemalbumin","description":"Methemalbumin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36474","name":"Endovenous mchnchem add-on","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25443","name":"Arthrp prostc dstl scph crpl","description":"Arthroplasty with prosthetic replacement; scaphoid carpal (navicular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":661.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2221","name":"Solid caster tire repl, each","description":"Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75887","name":"Vein x-ray liver w/o hemodyn","description":"Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2335","name":"Anterior swing band","description":"Addition to lower extremity, anterior swing band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62263","name":"Epidural lysis mult sessions","description":"Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 2 or more days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93297","name":"Rem interrog dev eval icpms","description":"Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other quali","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23332","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":665.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82105","name":"Alpha-fetoprotein serum","description":"Alpha-fetoprotein (afp); serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27266","name":"Treat hip dislocation","description":"Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":490.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15005","name":"Wnd prep f/n/hf/g addl cm","description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each additional 100 sq cm, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0518T","name":"Rmvl pg wcs lv battery only","description":"Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; battery component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19305","name":"Mast radical","description":"Mastectomy, radical, including pectoral muscles, axillary lymph nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83570","name":"Assay of idh enzyme","description":"Isocitric dehydrogenase (idh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22843","name":"Insert spine fixation device","description":"Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2000","name":"Gastric suction pump hme mdl","description":"Gastric suction pump, home model, portable or stationary, electric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99281","name":"Emr dpt vst mayx req phy/qhp","description":"Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0160","name":"Sitz type bath or equipment","description":"Sitz type bath or equipment, portable, used with or without commode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59020","name":"Fetal contract stress test","description":"Fetal contraction stress test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36227","name":"Place cath xtrnl carotid","description":"Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4456","name":"Adhesive remover, wipes","description":"Adhesive remover, wipes, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2616","name":"Pos back post/lat wdth>=22in","description":"Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74775","name":"X-ray exam of perineum","description":"Perineogram (eg, vaginogram, for sex determination or extent of anomalies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8911","name":"Mra w/o fol w/cont, chest","description":"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98971","name":"Nqhp ol dig assmt&mgmt 11-20","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45330","name":"Diagnostic sigmoidoscopy","description":"Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53200","name":"Biopsy of urethra","description":"Biopsy of urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70330","name":"X-ray exam of jaw joints","description":"Radiologic examination, temporomandibular joint, open and closed mouth; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31000","name":"Irrigation maxillary sinus","description":"Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57511","name":"Cryocautery of cervix","description":"Cautery of cervix; cryocautery, initial or repeat","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94662","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77772","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64911","name":"Neurorraphy w/vein autograft","description":"Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":865.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50387","name":"Change nephroureteral cath","description":"Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29445","name":"Appl rigid tot cntc leg cast","description":"Application of rigid total contact leg cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84066","name":"Assay prostate phosphatase","description":"Phosphatase, acid; prostatic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74420","name":"Urography rtrgr +-kub","description":"Urography, retrograde, with or without kub","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15828","name":"Rhytidectomy cheek chn & nck","description":"Rhytidectomy; cheek, chin, and neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":985.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29901","name":"Mcp joint arthroscopy surg","description":"Arthroscopy, metacarpophalangeal joint, surgical; with debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64447","name":"Njx aa&/strd femoral nrv img","description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4330","name":"Stool collection pouch","description":"Perianal fecal collection pouch with adhesive, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27230","name":"Treat thigh fracture","description":"Closed treatment of femoral fracture, proximal end, neck; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":404.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27394","name":"Lengthening of thigh tendons","description":"Lengthening of hamstring tendon; multiple tendons, 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99496","name":"Transj care mgmt high f2f 7d","description":"Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge high level of medical decision making during the service period face-to-face visit, within 7 calenda","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32507","name":"Wedge resect of lung diag","description":"Thoracotomy; with diagnostic wedge resection followed by anatomic lung resection (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14021","name":"Tis trnfr s/a/l 10.1-30 sqcm","description":"Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93662","name":"Intracardiac ecg (ice)","description":"Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83655","name":"Assay of lead","description":"Lead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81050","name":"Urinalysis volume measure","description":"Volume measurement for timed collection, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2502","name":"Sgd prerec msg >8min <=20min","description":"Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82247","name":"Bilirubin total","description":"Bilirubin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0673","name":"Pressure pneum appl half leg","description":"Segmental gradient pressure pneumatic appliance, half leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96369","name":"Sc ther infusion up to 1 hr","description":"Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41823","name":"Excision of gum lesion","description":"Excision of osseous tuberosities, dentoalveolar structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21143","name":"Rcnstj mdface lefort i 3/>pc","description":"Reconstruction midface, lefort i; 3 or more pieces, segment movement in any direction, without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1140.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24600","name":"Tx clsd elbow dislc w/o anes","description":"Treatment of closed elbow dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":310.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15116","name":"Epdrm agrft f/s/n/h/f/g/m ea","description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50974","name":"Ureter endoscopy & biopsy","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34702","name":"Evasc rpr a-ao ndgft rpt","description":"Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84485","name":"Assay duodenal fluid trypsin","description":"Trypsin; duodenal fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92997","name":"Pul art balloon repr percut","description":"Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":666.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38500","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88363","name":"Xm archive tissue molec anal","description":"Examination and selection of retrieved archival (ie, previously diagnosed) tissue(s) for molecular analysis (eg, kras mutational analysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49014","name":"Reexploration pelvic wound","description":"Re-exploration of pelvic wound with removal of preperitoneal pelvic packing, including repacking, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36511","name":"Apheresis wbc","description":"Therapeutic apheresis; for white blood cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33214","name":"Upgrade of pacemaker system","description":"Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":413.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83909","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67108","name":"Repair detached retina","description":"Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24370","name":"Revise reconst elbow joint","description":"Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1302.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33203","name":"Insert epicard eltrd endo","description":"Insertion of epicardial electrode(s); endoscopic approach (eg, thoracoscopy, pericardioscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61512","name":"Crnec treph exc mngioma sttl","description":"Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2344.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27054","name":"Removal of hip joint lining","description":"Arthrotomy with synovectomy, hip joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1084","name":"Hemi-wheelchair detachable a","description":"Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0403","name":"Ekg for initial prevent exam","description":"Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93321","name":"Doppler echo f-up/lmtd std","description":"Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); follow-up or limited study (list separately in addition to codes for echocardiographic imaging)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93524","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31520","name":"Dx laryngoscopy newborn","description":"Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88174","name":"Cytopath c/v auto in fluid","description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49606","name":"Repair umbilical lesion","description":"Repair of large omphalocele or gastroschisis; with removal of prosthesis, final reduction and closure, in operating room","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00216","name":"Anes icr px vascular px","description":"Anesthesia for intracranial procedures; vascular procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36148","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67041","name":"Vit for macular pucker","description":"Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45136","name":"Excise ileoanal reservior","description":"Excision of ileoanal reservoir with ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1396.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00732","name":"Anes upr gi ndsc px ercp","description":"Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ercp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0218T","name":"Njx paravert w/us lumb/sac","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; third and any additional level(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45341","name":"Sigmoidoscopy w/ultrasound","description":"Sigmoidoscopy, flexible; with endoscopic ultrasound examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76872","name":"Us transrectal","description":"Ultrasound, transrectal;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3760","name":"Eo adj jt prefab custom fit","description":"Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific  patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":221.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57545","name":"Remove cervix/repair pelvis","description":"Excision of cervical stump, abdominal approach; with pelvic floor repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11311","name":"Shave skin lesion 0.6-1.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27498","name":"Decompression of thigh/knee","description":"Decompression fasciotomy, thigh and/or knee, multiple compartments;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28272","name":"Release of toe joint each","description":"Capsulotomy; interphalangeal joint, each joint (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0425","name":"Inpt/ed teleconsult30","description":"Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6722","name":"Hook/hand, hvy dty, vol clos","description":"Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2325","name":"Sip and puff interface","description":"Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32852","name":"Lung transplant with bypass","description":"Lung transplant, single; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33496","name":"Repair prosth valve clot","description":"Repair of non-structural prosthetic valve dysfunction with cardiopulmonary bypass (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1443.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45005","name":"Drainage of rectal abscess","description":"Incision and drainage of submucosal abscess, rectum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4388","name":"Drainable pch w ex wear barr","description":"Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0358T","name":"Bia whole body","description":"Bioelectrical impedance analysis whole body composition assessment, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0603","name":"Electric breast pump","description":"Breast pump, electric (ac and/or dc), any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64744","name":"Incise nerve back of head","description":"Transection or avulsion of; greater occipital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9983","name":"Remote e/m est. pt 10mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86161","name":"Complement/function activity","description":"Complement; functional activity, each component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19297","name":"Place breast cath for rad","description":"Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21260","name":"Revise eye sockets","description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1159.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01382","name":"Anes dx arthrs px knee jt","description":"Anesthesia for diagnostic arthroscopic procedures of knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76645","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65782","name":"Ocular reconst transplant","description":"Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":690.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78453","name":"Ht muscle image planar sing","description":"Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59866","name":"Abortion (mpr)","description":"Multifetal pregnancy reduction(s) (mpr)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78111","name":"Plasma volume multiple","description":"Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0277","name":"Hbot, full body chamber, 30m","description":"Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61584","name":"Orbitocranial approach/skull","description":"Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); without orbital exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76496","name":"Unlisted fluoroscopic px","description":"Unlisted fluoroscopic procedure (eg, diagnostic, interventional)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87427","name":"Shiga-like toxin ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; shiga-like toxin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4310","name":"Insert tray w/o bag/cath","description":"Insertion tray without drainage bag and without catheter (accessories only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0669","name":"Seg pneumatic appli half leg","description":"Segmental pneumatic appliance for use with pneumatic compressor, half leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99284","name":"Emergency dept visit mod mdm","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21615","name":"Excision 1st &/cervical rib","description":"Excision first and/or cervical rib;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23000","name":"Rmvl sbdltd clcreous dep opn","description":"Removal of subdeltoid calcareous deposits, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46250","name":"Remove ext hem groups 2+","description":"Hemorrhoidectomy, external, 2 or more columns/groups","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77072","name":"Bone age studies","description":"Bone age studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64782","name":"Remove limb nerve lesion","description":"Excision of neuroma; hand or foot, except digital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":372.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11462","name":"Exc skn hdrdnt ing smpl/ntrm","description":"Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44403","name":"Colonoscopy w/resection","description":"Colonoscopy through stoma; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61460","name":"Crnec sopl sctj 1+crnl nrv","description":"Craniectomy, suboccipital; for section of 1 or more cranial nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1930.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84580","name":"Assay of urine urobilinogen","description":"Urobilinogen, urine; quantitative, timed specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0155","name":"Walker wheel attachment,pair","description":"Wheel attachment, rigid pick-up walker, per pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3967","name":"Sewho airplane w/o jnts cf","description":"Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":877.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33366","name":"Trcath replace aortic valve","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; transapical exposure (eg, left thoracotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25274","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8430","name":"Prosthetic sock multi ply ak","description":"Prosthetic sock, multiple ply, above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40525","name":"Reconstruct lip with flap","description":"Excision of lip; full thickness, reconstruction with local flap (eg, estlander or fan)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":433.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11901","name":"Inject skin lesions >7","description":"Injection, intralesional; more than 7 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36818","name":"Av fuse uppr arm cephalic","description":"Arteriovenous anastomosis, open; by upper arm cephalic vein transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2002","name":"Post-d/c h vst new pt 30 m","description":"Limited (30 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58322","name":"Artificial insemination","description":"Artificial insemination; intra-uterine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43235","name":"Egd diagnostic brush wash","description":"Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36810","name":"Insertion of cannula","description":"Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external (scribner type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4373","name":"Skin barrier with flange","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57300","name":"Repair rectum-vagina fistula","description":"Closure of rectovaginal fistula; vaginal or transanal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":378.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21385","name":"Opn tx orbit fx transantral","description":"Open treatment of orbital floor blowout fracture; transantral approach (caldwell-luc type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":624.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88267","name":"Chromosome analys placenta","description":"Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, 1 karyotype, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0973","name":"W/ch access det adj armrest","description":"Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78215","name":"Lvr&spleen img static only","description":"Liver and spleen imaging; static only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33224","name":"Insert pacing lead & connect","description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29856","name":"Tibial arthroscopy/surgery","description":"Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes internal fixation, when performed (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":837.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35515","name":"Art byp grft subclav-vertbrl","description":"Bypass graft, with vein; subclavian-vertebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1171.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75898","name":"Follow-up angiography","description":"Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","59","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5613","name":"Ak 4 bar ling w/hydraul swig","description":"Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82355","name":"Calculus analysis qual","description":"Calculus; qualitative analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46080","name":"Sphnctrotmy anal div sphnctr","description":"Sphincterotomy, anal, division of sphincter (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9538","name":"Tc99m pyrophosphate","description":"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21330","name":"Open tx nose fx w/skele fixj","description":"Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64738","name":"Incision of jaw nerve","description":"Transection or avulsion of; inferior alveolar nerve by osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":361.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P3001","name":"Screening pap smear by phys","description":"Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0296T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86900","name":"Blood typing serologic abo","description":"Blood typing, serologic; abo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87172","name":"Pinworm exam","description":"Pinworm exam (eg, cellophane tape prep)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17003","name":"Destruct premalg les 2-14","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (list separately in addition to code for first lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36560","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88299","name":"Unlisted cytogenetic study","description":"Unlisted cytogenetic study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42804","name":"Biopsy of upper nose/throat","description":"Biopsy; nasopharynx, visible lesion, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41114","name":"Excision of tongue lesion","description":"Excision of lesion of tongue with closure; with local tongue flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":478.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44021","name":"Decompress small bowel","description":"Enterotomy, small intestine, other than duodenum; for decompression (eg, baker tube)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73720","name":"Mri lwr extremity w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7046","name":"Repl water chamber, pap dev","description":"Water chamber for humidifier, used with positive airway pressure device, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7040","name":"Prehensile actuator","description":"Prehensile actuator, switch controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42107","name":"Excision lesion mouth roof","description":"Excision, lesion of palate, uvula; with local flap closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0413","name":"Pelvic ring fracture uni/bil","description":"Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":692.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0015","name":"Detach non-adj ht armrst rep","description":"Detachable, non-adjustable height armrest, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6320","name":"Shoulder passive restor cap","description":"Shoulder disarticulation, passive restoration (shoulder cap only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":848.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26460","name":"Incise hand/finger tendon","description":"Tenotomy, extensor, hand or finger, open, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1840","name":"Adj shoulder ext/flex device","description":"Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66180","name":"Aqueous shunt eye w/graft","description":"Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1026.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83701","name":"Lipoprotein bld hr fraction","description":"Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96935","name":"Rcm img acquisj only ea addl","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition only, each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00754","name":"Anes hrna rpr omphalocele","description":"Anesthesia for hernia repairs in upper abdomen; omphalocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70490","name":"Ct soft tissue neck w/o dye","description":"Computed tomography, soft tissue neck; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11312","name":"Shave skin lesion 1.1-2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96571","name":"Photodynamic tx addl 15 min","description":"Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (list separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27356","name":"Remove femur lesion/graft","description":"Excision or curettage of bone cyst or benign tumor of femur; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":623.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46754","name":"Removal of suture from anus","description":"Removal of thiersch wire or suture, anal canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19101","name":"Biopsy of breast open","description":"Biopsy of breast; open, incisional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87185","name":"Sc std enzyme detcj per nzm","description":"Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25000","name":"Incision of tendon sheath","description":"Incision, extensor tendon sheath, wrist (eg, de quervains disease)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4045","name":"Replace non-molded thigh lac","description":"Replace non-molded thigh lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3213","name":"Benesch boot pair child","description":"Benesch boot, pair, child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43327","name":"Esoph fundoplasty lap","description":"Esophagogastric fundoplasty partial or complete; laparotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":684.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4104","name":"Additive for enteral formula","description":"Additive for enteral formula (e.g., fiber)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53601","name":"Dilate urethra stricture","description":"Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57160","name":"Insert pessary/other device","description":"Fitting and insertion of pessary or other intravaginal support device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33410","name":"Replacement aortic valve opn","description":"Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2213.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01935","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0130","name":"Walker rigid adjust/fixed ht","description":"Walker, rigid (pickup), adjustable or fixed height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87496","name":"Cytomeg dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); cytomegalovirus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87166","name":"Dark field exam w/o collj","description":"Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0144T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31530","name":"Laryngoscopy w/fb removal","description":"Laryngoscopy, direct, operative, with foreign body removal;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34520","name":"Cross-over vein graft","description":"Cross-over vein graft to venous system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4256","name":"Calibrator solution/chips","description":"Normal, low and high calibrator solution / chips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","KL","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52300","name":"Cystoscopy and treatment","description":"Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63277","name":"Bx/exc xdrl spine lesn lmbr","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1399.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0149T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":367.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3030","name":"Foot arch support remov prem","description":"Foot, insert, removable, formed to patient foot, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91022","name":"Duodenal motility study","description":"Duodenal motility (manometric) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63173","name":"Drainage of spinal cyst","description":"Laminectomy with drainage of intramedullary cyst/syrinx; to peritoneal or pleural space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1575.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00474","name":"Anes prtl rib rescj rad px","description":"Anesthesia for partial rib resection; radical procedures (eg, pectus excavatum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0512T","name":"Esw integ wnd hlg 1st wnd","description":"Extracorporeal shock wave for integumentary wound healing, including topical application and dressing care; initial wound","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2104","name":"Spherocylindr 4.00d/2.12-4d","description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52320","name":"Cystoscopy and treatment","description":"Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22634","name":"Arthrd cmbn 1ntrspc ea addl","description":"Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (list separately in addition to code for prima","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":444.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43831","name":"Gastrostomy open neonatal","description":"Gastrostomy, open; neonatal, for feeding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87900","name":"Phenotype infect agent drug","description":"Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5824","name":"Endo knee-shin fluid swing p","description":"Addition, endoskeletal knee-shin system, single axis, fluid swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0879","name":"Pwc gp4 hd sing pow opt s/b","description":"Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3995","name":"Sock fracture or equal each","description":"Addition to upper extremity orthosis, sock, fracture or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5270","name":"Tilt table locking hip sing","description":"Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2551.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21820","name":"Treat sternum fracture","description":"Closed treatment of sternum fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82135","name":"Assay aminolevulinic acid","description":"Aminolevulinic acid, delta (ala)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74177","name":"Ct abd & pelvis w/contrast","description":"Computed tomography, abdomen and pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32400","name":"Needle biopsy chest lining","description":"Biopsy, pleura, percutaneous needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95930","name":"Visual ep test cns w/i&r","description":"Visual evoked potential (vep) checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33766","name":"Shunt supr v/c p-art 1 lung","description":"Shunt; superior vena cava to pulmonary artery for flow to 1 lung (classical glenn procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1158.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49560","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":614.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0691","name":"Uvl pnl 2 sq ft or less","description":"Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7038","name":"Pos airway pressure filter","description":"Filter, disposable, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80426","name":"Gonadotropin hormone panel","description":"Gonadotropin releasing hormone stimulation panel this panel must include the following: follicle stimulating hormone (fsh) (83001 x 4) luteinizing hormone (lh) (83002 x 4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91200","name":"Liver elastography","description":"Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82172","name":"Assay of apolipoprotein","description":"Apolipoprotein, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2190","name":"Waist belt","description":"Addition to lower extremity fracture orthosis, waist belt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93893","name":"Tcd std icr art ven-art shnt","description":"Transcranial doppler study of the intracranial arteries; venous-arterial shunt detection with intravenous microbubble injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43212","name":"Esophagoscop stent placement","description":"Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12045","name":"Intmd rpr n-hf/genit12.6-20","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":257.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5622","name":"Test socket knee disarticula","description":"Addition to lower extremity, test socket, knee disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50392","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64837","name":"Repair nerve add-on","description":"Suture of each additional nerve, hand or foot (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62287","name":"Dcmprn pq nuc pul 1/mlt lmbr","description":"Decompression, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle-based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, sing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":473.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36513","name":"Apheresis platelets","description":"Therapeutic apheresis; for platelets","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45308","name":"Proctosigmoidoscopy removal","description":"Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75978","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41100","name":"Biopsy of tongue","description":"Biopsy of tongue; anterior two-thirds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0443","name":"Brief alcohol misuse counsel","description":"Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27619","name":"Exc leg/ankle tum deep <5 cm","description":"Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27360","name":"Partial removal leg bone(s)","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":739.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27499","name":"Decompression of thigh/knee","description":"Decompression fasciotomy, thigh and/or knee, multiple compartments; with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":591.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1170","name":"Whlchr ampu fxd arm leg rest","description":"Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55300","name":"Prepare sperm duct x-ray","description":"Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68326","name":"Revise/graft eyelid lining","description":"Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":387.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86335","name":"Immunfix e-phorsis/urine/csf","description":"Immunofixation electrophoresis; other fluids with concentration (eg, urine, csf)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25028","name":"I&d f/arm&/wrst dp absc/hmtm","description":"Incision and drainage, forearm and/or wrist; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":494.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00160","name":"Anes px nose&sinus nos","description":"Anesthesia for procedures on nose and accessory sinuses; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70552","name":"Mri brain stem w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":243.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81305","name":"Myd88 gene p.leu265pro vrnt","description":"Myd88 (myeloid differentiation primary response 88) (eg, waldenstroms macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.leu265pro (l265p) variant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90911","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29837","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; debridement, limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5082","name":"Continent stoma catheter","description":"Continent device; catheter for continent stoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11755","name":"Biopsy nail unit","description":"Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23073","name":"Exc shoulder tum deep 5 cm/>","description":"Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":594.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24675","name":"Cltx ulnar fx prox w/mnpj","description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85660","name":"Rbc sickle cell test","description":"Sickling of rbc, reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44364","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53661","name":"Dilation of urethra","description":"Dilation of female urethra including suppository and/or instillation; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74160","name":"Ct abdomen w/contrast","description":"Computed tomography, abdomen; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32491","name":"Lung volume reduction","description":"Removal of lung, other than pneumonectomy; with resection-plication of emphysematous lung(s) (bullous or non-bullous) for lung volume reduction, sternal split or transthoracic approach, includes any pleural procedure, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1174.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10040","name":"Extraction","description":"Extraction (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1028","name":"W/c manual swingaway","description":"Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93459","name":"L hrt art/grft angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter place","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35121","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, hepatic, celiac, renal, or mesenteric artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99605","name":"Mtms by pharm np 15 min","description":"Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, new patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79300","name":"Nuclr rx interstit colloid","description":"Radiopharmaceutical therapy, by interstitial radioactive colloid administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5105","name":"Urinary suspensory","description":"Urinary suspensory with leg bag, with or without tube, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64491","name":"Inj paravert f jnt c/t 2 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), cervical or thoracic; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52442","name":"Cysto ins trnsprstc implt ea","description":"Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0136","name":"Adm of pa/n assess 5-15 m","description":"Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8641","name":"Metatarsal joint implant","description":"Metatarsal joint implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49426","name":"Revise abdomen-venous shunt","description":"Revision of peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":557.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85380","name":"Fibrin degradj d-dimer","description":"Fibrin degradation products, d-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32820","name":"Reconstruct injured chest","description":"Major reconstruction, chest wall (posttraumatic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1060.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82947","name":"Assay glucose blood quant","description":"Glucose; quantitative, blood (except reagent strip)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30450","name":"Revision of nose","description":"Rhinoplasty, secondary; major revision (nasal tip work and osteotomies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96446","name":"Chemotx admn pertl cav impl","description":"Chemotherapy administration into the peritoneal cavity via implanted port or catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5644","name":"Above knee wood socket","description":"Addition to lower extremity, above knee, wood socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5920","name":"Endo ak/hip alignable system","description":"Addition, endoskeletal system, above knee or hip disarticulation, alignable system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31626","name":"Bronchoscopy w/markers","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0801","name":"Pov group 1 hd 301-450 lbs","description":"Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82930","name":"Gastric analy w/ph ea spec","description":"Gastric acid analysis, includes ph if performed, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64484","name":"Njx aa&/strd tfrm epi l/s ea","description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or ct), lumbar or sacral, each additional level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36221","name":"Place cath thoracic aorta","description":"Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3570","name":"O shoe add instep extension","description":"Orthopedic shoe addition, special extension to instep (leather with eyelets)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71045","name":"X-ray exam chest 1 view","description":"Radiologic examination, chest; single view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67830","name":"Revise eyelashes","description":"Correction of trichiasis; incision of lid margin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":164.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01714","name":"Anes nrv msc upr a&e tnplsty","description":"Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenoplasty, elbow to shoulder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67917","name":"Repair eyelid defect","description":"Repair of ectropion; extensive (eg, tarsal strip operations)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":375.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58356","name":"Endometrial cryoablation","description":"Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91065","name":"Breath hydrogen/methane test","description":"Breath hydrogen or methane test (eg, for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal gastrointestinal transit)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2224","name":"Propulsion whl excl tire rep","description":"Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26135","name":"Revise finger joint each","description":"Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":461.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26412","name":"Repair/graft hand tendon","description":"Repair, extensor tendon, hand, primary or secondary; with free graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61533","name":"Implant brain electrodes","description":"Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term seizure monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60300","name":"Aspir/inj thyroid cyst","description":"Aspiration and/or injection, thyroid cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93580","name":"Transcath closure of asd","description":"Percutaneous transcatheter closure of congenital interatrial communication (ie, fontan fenestration, atrial septal defect) with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1035.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2106","name":"Spherocylinder 4.00d/>6.00d","description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82646","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00120","name":"Anes px ear w/bx nos","description":"Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24075","name":"Exc arm/elbow les sc < 3 cm","description":"Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51520","name":"Removal of bladder lesion","description":"Cystotomy; for simple excision of vesical neck (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":481.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64752","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40818","name":"Excise oral mucosa for graft","description":"Excision of mucosa of vestibule of mouth as donor graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54670","name":"Repair testis injury","description":"Suture or repair of testicular injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":329.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81239","name":"Dmpk gene charac alleles","description":"Dmpk (dm1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; characterization of alleles (eg, expanded size)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67830","name":"Revise eyelashes","description":"Correction of trichiasis; incision of lid margin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35565","name":"Art byp grft iliofemoral","description":"Bypass graft, with vein; iliofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61151","name":"Burr hole/treph sbsq tapping","description":"Burr hole(s) or trephine; with subsequent tapping (aspiration) of intracranial abscess or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":902.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49423","name":"Exchange drainage catheter","description":"Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49452","name":"Replace g-j tube perc","description":"Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":672.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9143","name":"Warfarin respon genetic test","description":"Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01520","name":"Anes px veins lower leg nos","description":"Anesthesia for procedures on veins of lower leg; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77789","name":"Apply surf ldr radionuclide","description":"Surface application of low dose rate radionuclide source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45378","name":"Diagnostic colonoscopy","description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","53"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78020","name":"Thyroid met uptake","description":"Thyroid carcinoma metastases uptake (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51725","name":"Simple cystometrogram","description":"Simple cystometrogram (cmg) (eg, spinal manometer)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86200","name":"Ccp antibody","description":"Cyclic citrullinated peptide (ccp), antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86703","name":"Hiv-1/hiv-2 1 result antbdy","description":"Antibody; hiv-1 and hiv-2, single result","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43235","name":"Egd diagnostic brush wash","description":"Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33924","name":"Remove pulmonary shunt","description":"Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95836","name":"Ecog impltd brn npgt <30 d","description":"Electrocorticogram from an implanted brain neurostimulator pulse generator/transmitter, including recording, with interpretation and written report, up to 30 days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4543","name":"Adult disp brief/diap abv xl","description":"Adult sized disposable incontinence product, protective brief/diaper, above extra large, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27886","name":"Amputation follow-up surgery","description":"Amputation, leg, through tibia and fibula; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":563.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64719","name":"Revise ulnar nerve at wrist","description":"Neuroplasty and/or transposition; ulnar nerve at wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":335.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40816","name":"Excision of mouth lesion","description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82930","name":"Gastric analy w/ph ea spec","description":"Gastric acid analysis, includes ph if performed, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84233","name":"Assay of estrogen","description":"Receptor assay; estrogen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90901","name":"Biofeedback train any meth","description":"Biofeedback training by any modality","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0461","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43762","name":"Rplc gtube no revj trc","description":"Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76882","name":"Us lmtd jt/fcl evl nvasc xtr","description":"Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0072","name":"Fr cstr semi-pne tire rep ea","description":"Front caster assembly, complete, with semi-pneumatic tire, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24370","name":"Revise reconst elbow joint","description":"Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31300","name":"Removal of larynx lesion","description":"Laryngotomy (thyrotomy, laryngofissure), with removal of tumor or laryngocele, cordectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00410","name":"Anes integ sys conv arrhyt","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; electrical conversion of arrhythmias","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88165","name":"Cytopath tbs c/v redo","description":"Cytopathology, slides, cervical or vaginal (the bethesda system); with manual screening and rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87625","name":"Hpv types 16 & 18 only","description":"Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), types 16 and 18 only, includes type 45, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33511","name":"Cabg vein two","description":"Coronary artery bypass, vein only; 2 coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1846.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87070","name":"Culture othr specimn aerobic","description":"Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95800","name":"Slp stdy unattended","description":"Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64633","name":"Destroy cerv/thor facet jnt","description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); cervical or thoracic, single facet joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":335.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88289","name":"Chromosome study additional","description":"Chromosome analysis; additional high resolution study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22859","name":"Insj biomechanical device","description":"Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31554","name":"Laryngoplasty laryngeal sten","description":"Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93597","name":"R&l hrt cath chd abnl nt cnj","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 native connections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":378.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96574","name":"Dbrdmt prmlg les w/pdt","description":"Debridement of premalignant hyperkeratotic lesion(s) (ie, targeted curettage, abrasion) followed with photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27632","name":"Exc leg/ankle les sc 3 cm/>","description":"Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43231","name":"Esophagoscop ultrasound exam","description":"Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64902","name":"Nerve graft add-on","description":"Nerve graft, each additional nerve; multiple strands (cable) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35606","name":"Bpg carotid-subclavian","description":"Bypass graft, with other than vein; carotid-subclavian","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1031.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29836","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; synovectomy, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64804","name":"Sympathectomy cervicothorac","description":"Sympathectomy, cervicothoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1075.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83695","name":"Assay of lipoprotein(a)","description":"Lipoprotein (a)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61799","name":"Srs cran les complex addl","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, complex (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63620","name":"Srs spinal lesion","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0627","name":"Seat lift mech, electric any","description":"Seat lift mechanism, electric, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93307","name":"Tte w/o doppler complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35305","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1078.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27001","name":"Tenotomy adductor hip open","description":"Tenotomy, adductor of hip, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15789","name":"Chemical peel facial dermal","description":"Chemical peel, facial; dermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87169","name":"Macroscopic exam parasite","description":"Macroscopic examination; parasite","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33645","name":"Revision of heart veins","description":"Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43282","name":"Lap paraesoph her rpr w/mesh","description":"Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1455.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17313","name":"Mohs 1 stage t/a/l","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56700","name":"Prtl hymnctmy/revj hymnl rng","description":"Partial hymenectomy or revision of hymenal ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84134","name":"Assay of prealbumin","description":"Prealbumin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25608","name":"Optx dst rd xart fx/epi sep2","description":"Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57061","name":"Destruction vag lesions smpl","description":"Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0500","name":"Mod sedat endo service >5yrs","description":"Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousness ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50250","name":"Opn abltj 1/> rnl mas crysrg","description":"Ablation, open, 1 or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound guidance and monitoring, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23500","name":"Cltx clavicular fx w/o mnpj","description":"Closed treatment of clavicular fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00528","name":"Anes clsd ch mediast&thrc wo","description":"Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy not utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26775","name":"Treat finger dislocation","description":"Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54230","name":"Njx corpora cavernosograpy","description":"Injection procedure for corpora cavernosography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51772","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6538","name":"Gc stocking full lngth 40+","description":"Gradient compression stocking, full length/chap style, 40 mmhg or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6257","name":"Transparent film <= 16 sq in","description":"Transparent film, sterile, 16 sq. in. or less, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15838","name":"Exc excsv submental fat pad","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99152","name":"Mod sed same phys/qhp 5/>yrs","description":"Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56633","name":"Vulvectomy radical complete","description":"Vulvectomy, radical, complete;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93451","name":"Right heart cath","description":"Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":843.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61120","name":"Burr hole for ventr puncture","description":"Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63706","name":"Repair of spinal herniation","description":"Repair of myelomeningocele; larger than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1678.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8185","name":"Flutter device","description":"Flutter device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68700","name":"Repair tear ducts","description":"Plastic repair of canaliculi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26145","name":"Tendon excision palm/finger","description":"Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95983","name":"Alys brn npgt prgrmg 15 min","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0602","name":"Repl batt silver oxide 3 v","description":"Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27591","name":"Amputate leg at thigh","description":"Amputation, thigh, through femur, any level; immediate fitting technique including first cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00792","name":"Anes iper upr abd prtl hptc","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage (excluding liver biopsy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32853","name":"Lung transplant double","description":"Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3703.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0419","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1532.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85576","name":"Blood platelet aggregation","description":"Platelet, aggregation (in vitro), each agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27759","name":"Treatment of tibia fracture","description":"Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53440","name":"Male sling procedure","description":"Sling operation for correction of male urinary incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":609.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21045","name":"Extensive jaw surgery","description":"Excision of malignant tumor of mandible; radical resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36014","name":"Place catheter in artery","description":"Selective catheter placement, left or right pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85008","name":"Bl smear w/o diff wbc count","description":"Blood count; blood smear, microscopic examination without manual differential wbc count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0508","name":"Crit care telehea consult 60","description":"Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84512","name":"Assay of troponin qual","description":"Troponin, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97606","name":"Neg prs wnd ther dme>50 sqcm","description":"Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (dme), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26420","name":"Repair/graft finger tendon","description":"Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27364","name":"Resect thigh/knee tum 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1335.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64653","name":"Chemodenerv eccrine glands","description":"Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, neck), per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0561","name":"Humidifier nonheated w pap","description":"Humidifier, non-heated, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28290","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":472.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83003","name":"Assay growth hormone (hgh)","description":"Growth hormone, human (hgh) (somatotropin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17276","name":"Dstr mal les s/n/h/f/g >4.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0482","name":"Tlso rigid lined custom fab","description":"Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts g","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28113","name":"Part removal of metatarsal","description":"Ostectomy, complete excision; fifth metatarsal head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99177","name":"Ocular instrumnt screen bil","description":"Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with on-site analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2783","name":"Lens, >= 1.66 p/>=1.80 g","description":"Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27217","name":"Treat pelvic ring fracture","description":"Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes pubic symphysis and/or ipsilateral superior/inferior rami)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":665.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25151","name":"Partial removal of radius","description":"Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); radius","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":487.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15736","name":"Muscle-skin graft arm","description":"Muscle, myocutaneous, or fasciocutaneous flap; upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":790.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22556","name":"Arthrd ant ntrbd min dsc thc","description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1467.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23330","name":"Remove shoulder foreign body","description":"Removal of foreign body, shoulder; subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":239.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29845","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; synovectomy, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1372","name":"Oxy suppl heater for nebuliz","description":"Immersion external heater for nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31653","name":"Bronch ebus samplng 3/> node","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":850.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65800","name":"Drainage of eye","description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83986","name":"Assay ph body fluid nos","description":"Ph; body fluid, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32555","name":"Aspirate pleura w/ imaging","description":"Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":229.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9488","name":"Remote e/m est. pt 25mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of modera","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58900","name":"Biopsy of ovary(s)","description":"Biopsy of ovary, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76831","name":"Echo exam uterus","description":"Saline infusion sonohysterography (sis), including color flow doppler, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8044","name":"Hemi-facial prosthesis","description":"Hemi-facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","KM","95","93","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2206","name":"Man wc whl lock comp repl ea","description":"Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47534","name":"Plmt biliary drainage cath","description":"Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95075","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43333","name":"Transab esoph hiat hern rpr","description":"Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29867","name":"Allgrft implnt knee w/scope","description":"Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48556","name":"Removal allograft pancreas","description":"Removal of transplanted pancreatic allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31637","name":"Bronchoscopy stent add-on","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; each additional major bronchus stented (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7009","name":"Nebulizer reservoir bottle","description":"Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93248","name":"Ext ecg>7d<15d rev&interpj","description":"External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78070","name":"Parathyroid planar imaging","description":"Parathyroid planar imaging (including subtraction, when performed);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3332","name":"Shoe lifts tapered to one-ha","description":"Lift, elevation, inside shoe, tapered, up to one-half inch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43401","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1196.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1297","name":"Wheelchair special seat dept","description":"Special wheelchair seat depth, by upholstery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64487","name":"Tap block uni by infusion","description":"Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) unilateral; by continuous infusion(s) (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":144.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69155","name":"Extensive ear/neck surgery","description":"Radical excision external auditory canal lesion; with neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1325.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00904","name":"Anes radical perineal px","description":"Anesthesia for; radical perineal procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4259","name":"Lancets per box","description":"Lancets, per box of 100","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6203","name":"Composite drsg <= 16 sq in","description":"Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4432","name":"Os pch urine w bar/fange/tap","description":"Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2314","name":"Lens sphcyl trifocal over 12","description":"Spherocylinder, trifocal, sphere over plus or minus 12.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24361","name":"Reconstruct elbow joint","description":"Arthroplasty, elbow; with distal humeral prosthetic replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":852.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83519","name":"Ria nonantibody","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, ria)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80074","name":"Acute hepatitis panel","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)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99282","name":"Emergency dept visit sf mdm","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70320","name":"Full mouth x-ray of teeth","description":"Radiologic examination, teeth; complete, full mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5647","name":"Below knee suction socket","description":"Addition to lower extremity, below knee suction socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":413.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0499","name":"Belt/vest elec/combo vad rep","description":"Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50280","name":"Exc/unroofing cyst kidney","description":"Excision or unroofing of cyst(s) of kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01961","name":"Anes cesarean delivery only","description":"Anesthesia for cesarean delivery only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15336","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43352","name":"Surgical opening esophagus","description":"Esophagostomy, fistulization of esophagus, external; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34846","name":"Visc & infraren abd 2 prosth","description":"Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83695","name":"Assay of lipoprotein(a)","description":"Lipoprotein (a)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19318","name":"Breast reduction","description":"Breast reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":708.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A7011","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0807","name":"Pov group 2 hd 301-450 lbs","description":"Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4652","name":"Microcapillary tube sealant","description":"Microcapillary tube sealant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68550","name":"Remove tear gland lesion","description":"Excision of lacrimal gland tumor; involving osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67010","name":"Partial removal of eye fluid","description":"Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal with mechanical vitrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79445","name":"Nuclear rx intra-arterial","description":"Radiopharmaceutical therapy, by intra-arterial particulate administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25652","name":"Optx ulnar styloid fracture","description":"Open treatment of ulnar styloid fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":521.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64446","name":"Njx aa&/strd sc nrv nfs img","description":"Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92555","name":"Speech threshold audiometry","description":"Speech audiometry threshold;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97760","name":"Orthotic mgmt&traing 1st enc","description":"Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50125","name":"Pyelotomy w/drg pyelostomy","description":"Pyelotomy; with drainage, pyelostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63075","name":"Neck spine disk surgery","description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0470","name":"Rad w/o backup non-inv intfc","description":"Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20600","name":"Drain/inj joint/bursa w/o us","description":"Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93285","name":"Prgrmg dev eval scrms ip","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; subcutaneous cardiac rhythm mon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6007","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63087","name":"Remov vertbr dcmprn thrclmbr","description":"Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2143.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52700","name":"Drainage of prostate abscess","description":"Transurethral drainage of prostatic abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0506","name":"Comp asses care plan ccm svc","description":"Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27430","name":"Revision of thigh muscles","description":"Quadricepsplasty (eg, bennett or thompson type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":625.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99380","name":"Nursing fac care supervision","description":"Supervision of a nursing facility patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, comm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4328","name":"Fem urinary collect pouch","description":"Female external urinary collection device; pouch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3000","name":"Ft insert ucb berkeley shell","description":"Foot, insert, removable, molded to patient model, ucb type, berkeley shell, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78432","name":"Myocrd img pet 2rtracer","description":"Myocardial imaging, positron emission tomography (pet), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2244.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7025","name":"Replace chest compress vest","description":"High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6708","name":"Term dev mech hand vol open","description":"Terminal device, hand, mechanical, voluntary opening, any material, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46045","name":"I&d absc tranal under anes","description":"Incision and drainage of intramural, intramuscular, or submucosal abscess, transanal, under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0827","name":"Pwc gp vhd cap chair","description":"Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89225","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6900","name":"Hand restorat thumb/1 finger","description":"Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4010","name":"Replace trilateral socket br","description":"Replace trilateral socket brim","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":369.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78491","name":"Myocrd img pet 1std rst/strs","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":735.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84087","name":"Assay phosphohexose enzymes","description":"Phosphohexose isomerase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61250","name":"Burr hole/treph sttl expl","description":"Burr hole(s) or trephine, supratentorial, exploratory, not followed by other surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":786.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63085","name":"Remove vert body dcmprn thrc","description":"Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1709.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88106","name":"Cytopath fl nongyn filter","description":"Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82415","name":"Assay of chloramphenicol","description":"Chloramphenicol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62005","name":"Treat skull fracture","description":"Elevation of depressed skull fracture; compound or comminuted, extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1158.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99385","name":"Prev visit new age 18-39","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4635","name":"Underarm crutch pad","description":"Underarm pad, crutch, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28103","name":"Remove/graft foot lesion","description":"Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":307.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0514","name":"Prolong prev svcs, addl 30m","description":"Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87808","name":"Trichomonas assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; trichomonas vaginalis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58752","name":"Revise ovarian tube(s)","description":"Tubouterine implantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":581.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83037","name":"Hb glycosylated a1c home dev","description":"Hemoglobin; glycosylated (a1c) by device cleared by fda for home use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54530","name":"Removal of testis","description":"Orchiectomy, radical, for tumor; inguinal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92060","name":"Sensorimotor examination","description":"Sensorimotor examination with multiple measurements of ocular deviation (eg, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89230","name":"Collect sweat for test","description":"Sweat collection by iontophoresis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67010","name":"Partial removal of eye fluid","description":"Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal with mechanical vitrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":325.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69554","name":"Exc aurl glomus tum extended","description":"Excision aural glomus tumor; extended (extratemporal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4205","name":"Ortho dvc repair per 15 min","description":"Repair of orthotic device, labor component, per 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76886","name":"Us exam infant hips static","description":"Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60502","name":"Re-explore parathyroids","description":"Parathyroidectomy or exploration of parathyroid(s); re-exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1110.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50120","name":"Pyelotomy w/exploration","description":"Pyelotomy; with exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67901","name":"Repair eyelid defect","description":"Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35651","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1427.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0413","name":"Pelvic ring fracture uni/bil","description":"Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3595","name":"Ortho shoe add march bar","description":"Orthopedic shoe addition, march bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58740","name":"Adhesiolysis tube ovary","description":"Lysis of adhesions (salpingolysis, ovariolysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":579.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25690","name":"Cltx lunate dislc w/mnpj","description":"Closed treatment of lunate dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32658","name":"Thoracoscopy w/sac fb remove","description":"Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4604","name":"Tubing with heating element","description":"Tubing with integrated heating element for use with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4415","name":"Ost skn barr w/o conv >4 sqi","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2351","name":"Electronic sgd interface","description":"Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15829","name":"Rhytidectomy smas flap","description":"Rhytidectomy; superficial musculoaponeurotic system (smas) flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6676","name":"Harness figure of 8 dual con","description":"Upper extremity addition, harness, (e.g., figure of eight type), dual cable design","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81181","name":"Atxn7 gene detc abnor allele","description":"Atxn7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0019","name":"Comm hlth intg svs sdoh 60mn","description":"Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31253","name":"Nsl/sins ndsc total","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38570","name":"Laparoscopy lymph node biop","description":"Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":328.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31580","name":"Laryngoplasty laryngeal web","description":"Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":951.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96202","name":"Mlt fam grp bhv train 1st 60","description":"Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of paren","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82938","name":"Gastrin test","description":"Gastrin after secretin stimulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94780","name":"Cars/bd tst inft-12mo 60 min","description":"Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29515","name":"Application short leg splint","description":"Application of short leg splint (calf to foot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44135","name":"Intestine transplnt cadaver","description":"Intestinal allotransplantation; from cadaver donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62163","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1113.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0603","name":"Electric breast pump","description":"Breast pump, electric (ac and/or dc), any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01744","name":"Anes opn/arthrs elbw rpr hum","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; repair of nonunion or malunion of humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85441","name":"Heinz bodies direct","description":"Heinz bodies; direct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0505T","name":"Ev fempop artl revsc","description":"Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":986.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69550","name":"Exc aurl glomus tum trnscanl","description":"Excision aural glomus tumor; transcanal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":840.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61580","name":"Craniofacial approach skull","description":"Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2058.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35533","name":"Art byp grft axill/fem/fem","description":"Bypass graft, with vein; axillary-femoral-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95028","name":"Iq tsts allergy delayed rxn","description":"Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2034","name":"Kafo pla sin up w/wo k/a cus","description":"Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31660","name":"Bronch thermoplsty 1 lobe","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48001","name":"Placement of drain pancreas","description":"Placement of drains, peripancreatic, for acute pancreatitis; with cholecystostomy, gastrostomy, and jejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54328","name":"Revise penis/urethra","description":"1-stage distal hypospadias repair (with or without chordee or circumcision); with extensive dissection to correct chordee and urethroplasty with local skin flaps, skin graft patch, and/or island flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24675","name":"Cltx ulnar fx prox w/mnpj","description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92621","name":"Auditory function + 15 min","description":"Evaluation of central auditory function, with report; each additional 15 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93272","name":"Ecg/review interpret only","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87493","name":"C diff amplified probe","description":"Infectious agent detection by nucleic acid (dna or rna); clostridium difficile, toxin gene(s), amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0760","name":"Osteogen ultrasound stimltor","description":"Osteogenesis stimulator, low intensity ultrasound, non-invasive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62162","name":"Remove colloid cyst w/scope","description":"Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1727.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25112","name":"Reremove wrist tendon lesion","description":"Excision of ganglion, wrist (dorsal or volar); recurrent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0417","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":752.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5645","name":"Bk flex inner socket ext fra","description":"Addition to lower extremity, below knee, flexible inner socket, external frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":396.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31600","name":"Planned tracheostomy","description":"Tracheostomy, planned (separate procedure);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63185","name":"Incise spine nrv half segmnt","description":"Laminectomy with rhizotomy; 1 or 2 segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23460","name":"Repair shoulder capsule","description":"Capsulorrhaphy, anterior, any type; with bone block","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66987","name":"Xcapsl ctrc rmvl cplx w/ecp","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":498.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5976","name":"Energy storing foot","description":"All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73719","name":"Mri lower extremity w/dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":241.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1172","name":"Wheelchair amputee detach ar","description":"Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82946","name":"Glucagon tolerance test","description":"Glucagon tolerance test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78807","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":274.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86592","name":"Syphilis test non-trep qual","description":"Syphilis test, non-treponemal antibody; qualitative (eg, vdrl, rpr, art)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33264","name":"Rmvl & rplcmt dfb gen mlt ld","description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88333","name":"Path consltj surg cyto xm 1","description":"Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46050","name":"I&d perianal abscess supfc","description":"Incision and drainage, perianal abscess, superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45391","name":"Colonoscopy w/endoscope us","description":"Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95149","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 5 single stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90581","name":"Anthrax vaccine sc or im","description":"Anthrax vaccine, for subcutaneous or intramuscular use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4383","name":"Urinary rubber pouch w/o fp","description":"Ostomy pouch, urinary, for use on faceplate, rubber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95805","name":"Multiple sleep latency test","description":"Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":281.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58546","name":"Laparo-myomectomy complex","description":"Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19325","name":"Breast augmentation w/implt","description":"Breast augmentation with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":416.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","name":"Comprehen metabolic panel","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) potassium (84132) protein, total (84155) sodium ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76813","name":"Ob us nuchal meas 1 gest","description":"Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96000","name":"Motion analysis video/3d","description":"Comprehensive computer-based motion analysis by video-taping and 3d kinematics;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33877","name":"Thoracoabdominal graft","description":"Repair of thoracoabdominal aortic aneurysm with graft, with or without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3184.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92519","name":"Vemp tst i&r cervical&ocular","description":"Vestibular evoked myogenic potential (vemp) testing, with interpretation and report; cervical (cvemp) and ocular (ovemp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2040","name":"Hkafo torsion bil rot straps","description":"Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58110","name":"Bx done w/colposcopy add-on","description":"Endometrial sampling (biopsy) performed in conjunction with colposcopy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36221","name":"Place cath thoracic aorta","description":"Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":863.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4626","name":"Tracheostomy cleaning brush","description":"Tracheostomy cleaning brush, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21270","name":"Augmentation cheek bone","description":"Malar augmentation, prosthetic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27027","name":"Dcmprn fasct pel compartment","description":"Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87624","name":"Hpv hi-risk typ pooled rslt","description":"Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), pooled result","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21184","name":"Reconstruct cranial bone","description":"Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 80 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27675","name":"Repair lower leg tendons","description":"Repair, dislocating peroneal tendons; without fibular osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75833","name":"Vein x-ray kidneys","description":"Venography, renal, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28108","name":"Removal of toe lesions","description":"Excision or curettage of bone cyst or benign tumor, phalanges of foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":354.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49020","name":"Drainage abdom abscess open","description":"Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1319.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28055","name":"Neurectomy foot","description":"Neurectomy, intrinsic musculature of foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29580","name":"Strapping unna boot","description":"Strapping; unna boot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28360","name":"Reconstruct cleft foot","description":"Reconstruction, cleft foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0220","name":"Thor rib belt custom fabrica","description":"Thoracic, rib belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23044","name":"Arthrt ac sc jt exp/rmvl fb","description":"Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":477.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51065","name":"Remove ureter calculus","description":"Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54415","name":"Remove self-contd penis pros","description":"Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":428.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55040","name":"Removal of hydrocele","description":"Excision of hydrocele; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3740","name":"Cuffs adj lock w/ active con","description":"Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":601.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95860","name":"Needle emg 1 extremity","description":"Needle electromyography; 1 extremity with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5126","name":"Disk/foam pad +or- adhesive","description":"Adhesive or non-adhesive; disk or foam pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34708","name":"Evasc rpr ilio-iliac rpt","description":"Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1620.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0859","name":"Pwc gp3 hd sing pow opt cap","description":"Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57311","name":"Repair urethrovaginal lesion","description":"Closure of urethrovaginal fistula; with bulbocavernosus transplant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5112","name":"Urinary leg bag","description":"Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90792","name":"Psych diag eval w/med srvcs","description":"Psychiatric diagnostic evaluation with medical services","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76642","name":"Ultrasound breast limited","description":"Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4176","name":"Parenteral sol amino acid 7-","description":"Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78630","name":"Cerebrospinal fluid scan","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1833","name":"Ko adj jnt pos r sup pre ots","description":"Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4189","name":"Parenteral sol amino acid &","description":"Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4575","name":"Hyperbaric o2 chamber disps","description":"Topical hyperbaric oxygen chamber, disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21366","name":"Opn tx complx malar w/grft","description":"Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63011","name":"Remove spine lamina 1/2 scrl","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":942.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26426","name":"Repair finger/hand tendon","description":"Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); using local tissue(s), including lateral band(s), each finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28505","name":"Treat big toe fracture","description":"Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":540.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93042","name":"Rhythm ecg report","description":"Rhythm ecg, 1-3 leads; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25525","name":"Optx rdl shft fx&cltx rad/ul","description":"Open treatment of radial shaft fracture, includes internal fixation, when performed, and closed treatment of distal radioulnar joint dislocation (galeazzi fracture/ dislocation), includes percutaneous skeletal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":662.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5679","name":"Socket insert w/o lock mech","description":"Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64573","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82180","name":"Assay of ascorbic acid","description":"Ascorbic acid (vitamin c), blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2640","name":"Pelvic control band & belt b","description":"Addition to lower extremity, pelvic control, band and belt, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88155","name":"Cytopath c/v index add-on","description":"Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (list separately in addition to code[s] for other technical and interpretation services)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61692","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; dural, complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78650","name":"Csf leakage imaging","description":"Cerebrospinal fluid leakage detection and localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43247","name":"Egd remove foreign body","description":"Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0559T","name":"Antmc mdl 3d print 1st cmpnt","description":"Anatomic model 3d-printed from image data set(s); first individually prepared and processed component of an anatomic structure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84154","name":"Assay of psa free","description":"Prostate specific antigen (psa); free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5063","name":"Drain ostomy pouch w/flange","description":"Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35303","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; popliteal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1089.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45340","name":"Sig w/tndsc balloon dilation","description":"Sigmoidoscopy, flexible; with transendoscopic balloon dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83088","name":"Assay of histamine","description":"Histamine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70328","name":"X-ray exam of jaw joint","description":"Radiologic examination, temporomandibular joint, open and closed mouth; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0054T","name":"Bone srgry cmptr fluor image","description":"Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36251","name":"Ins cath ren art 1st unilat","description":"Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and inte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1136.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95131","name":"Immntx 2 sting insects","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1237","name":"Rgd ped wc adjstabl w/o seat","description":"Wheelchair, pediatric size, rigid, adjustable, without seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0100","name":"Cane adjust/fixed with tip","description":"Cane, includes canes of all materials, adjustable or fixed, with tip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94680","name":"O2 uptk rst&xers dir simple","description":"Oxygen uptake, expired gas analysis; rest and exercise, direct, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61702","name":"Inner skull vessel surgery","description":"Surgery of simple intracranial aneurysm, intracranial approach; vertebrobasilar circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3751.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12011","name":"Rpr f/e/e/n/l/m 2.5 cm/<","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33236","name":"Remove electrode/thoracotomy","description":"Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82570","name":"Assay of urine creatinine","description":"Creatinine; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52327","name":"Cystoscopy inject material","description":"Cystourethroscopy (including ureteral catheterization); with subureteric injection of implant material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45349","name":"Sigmoidoscopy w/resection","description":"Sigmoidoscopy, flexible; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0205","name":"Heat lamp with stand","description":"Heat lamp, with stand, includes bulb, or infrared element","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50135","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":907.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93926","name":"Lower extremity study","description":"Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27827","name":"Treat lower leg fracture","description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":934.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15155","name":"Tis cltr agrft f/s/n/h/f/g 1","description":"Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26230","name":"Partial removal of hand bone","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52450","name":"Transurethral inc prostate","description":"Transurethral incision of prostate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5707","name":"Custom shape cvr hip disart","description":"Custom shaped protective cover, hip disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":678.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88358","name":"Analysis tumor","description":"Morphometric analysis; tumor (eg, dna ploidy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66986","name":"Exchange lens prosthesis","description":"Exchange of intraocular lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":543.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27217","name":"Treat pelvic ring fracture","description":"Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes pubic symphysis and/or ipsilateral superior/inferior rami)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95052","name":"Photo patch tests","description":"Photo patch test(s) (specify number of tests)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61545","name":"Excision of brain tumor","description":"Craniotomy with elevation of bone flap; for excision of craniopharyngioma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2940.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89330","name":"Evaluation cervical mucus","description":"Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58545","name":"Laparoscopic myomectomy","description":"Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":577.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91052","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60280","name":"Remove thyroid duct lesion","description":"Excision of thyroglossal duct cyst or sinus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":364.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8670","name":"Vascular graft, synthetic","description":"Vascular graft material, synthetic, implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76512","name":"Oph us dx b-scan","description":"Ophthalmic ultrasound, diagnostic; b-scan (with or without superimposed non-quantitative a-scan)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4244","name":"Alcohol or peroxide per pint","description":"Alcohol or peroxide, per pint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84220","name":"Assay of pyruvate kinase","description":"Pyruvate kinase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0849","name":"Pwc gp 3 std cap chair","description":"Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50575","name":"Kidney endoscopy","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":577.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82554","name":"Creatine isoforms","description":"Creatine kinase (ck), (cpk); isoforms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13131","name":"Cmplx rpr f/c/c/m/n/ax/g/h/f","description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":241.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33881","name":"Evasc rpr ta ndgft xcov lsa","description":"Endovascular repair of thoracic aorta, including pre-procedure sizing and device selection, nonselective catheterization(s), all associated radiological supervision and interpretation; by deployment of an aorto-aortic tube endograft not involving coverage of the left subclavian artery origin and all","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86301","name":"Immunoassay tumor ca 19-9","description":"Immunoassay for tumor antigen, quantitative; ca 19-9","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19105","name":"Cryosurg ablate fa each","description":"Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1708.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67040","name":"Laser treatment of retina","description":"Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":623.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92521","name":"Evaluation of speech fluency","description":"Evaluation of speech fluency (eg, stuttering, cluttering)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25606","name":"Perq skel fixj dstl rdl fx","description":"Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":556.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21248","name":"Reconstruction of jaw","description":"Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28286","name":"Repair of hammertoe","description":"Correction, cock-up fifth toe, with plastic skin closure (eg, ruiz-mora type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":359.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93931","name":"Upper extremity study","description":"Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84410","name":"Testosterone bioavailable","description":"Testosterone; bioavailable, direct measurement (eg, differential precipitation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82978","name":"Assay of glutathione","description":"Glutathione","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36015","name":"Place catheter in artery","description":"Selective catheter placement, segmental or subsegmental pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":729.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00908","name":"Anes perineal prostatectomy","description":"Anesthesia for; perineal prostatectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20702","name":"Mnl prep&insj imed rx dev","description":"Manual preparation and insertion of drug-delivery device(s), intramedullary (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51060","name":"Removal of ureter stone","description":"Transvesical ureterolithotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57455","name":"Biopsy of cervix w/scope","description":"Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0065","name":"Spoke protectors","description":"Spoke protectors, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17260","name":"Dstrj mal les t/a/l 0.5 cm/<","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4390","name":"Drainable pch ex wear convex","description":"Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2745","name":"Tint, any color/solid/grad","description":"Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94772","name":"Circadian respir pattern rec","description":"Circadian respiratory pattern recording (pediatric pneumogram), 12-24 hour continuous recording, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28175","name":"Resect phalanx of toe tumor","description":"Radical resection of tumor; phalanx of toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88321","name":"Consltj&reprt sld prep elswr","description":"Consultation and report on referred slides prepared elsewhere","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75809","name":"Nonvascular shunt x-ray","description":"Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, leveen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46942","name":"Treatment of anal fissure","description":"Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80182","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99452","name":"Ntrprof ph1/ntrnet/ehr rfrl","description":"Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67916","name":"Repair eyelid defect","description":"Repair of ectropion; excision tarsal wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50961","name":"Ureter endoscopy & treatment","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82164","name":"Angiotensin i enzyme test","description":"Angiotensin i - converting enzyme (ace)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0402T","name":"Colgn crs-link crn&pachymtry","description":"Collagen cross-linking of cornea, including removal of the corneal epithelium, when performed, and intraoperative pachymetry, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36830","name":"Artery-vein nonautograft","description":"Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93457","name":"R hrt art/grft angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injecti","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1288.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88355","name":"M/phmtrc alys skeletal musc","description":"Morphometric analysis; skeletal muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28545","name":"Treat foot dislocation","description":"Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96567","name":"Pdt dstr prmlg les skn","description":"Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitive drug(s), per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43243","name":"Egd injection varices","description":"Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11976","name":"Remove contraceptive capsule","description":"Removal, implantable contraceptive capsules","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86005","name":"Allg spec ige multiallg scr","description":"Allergen specific ige; qualitative, multiallergen screen (eg, disk, sponge, card)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32671","name":"Thoracoscopy pneumonectomy","description":"Thoracoscopy, surgical; with removal of lung (pneumonectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1423.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7009","name":"Adult electric hook","description":"Electric hook, switch or myoelectric controlled, adult","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64636","name":"Destroy l/s facet jnt addl","description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); lumbar or sacral, each additional facet joint (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21270","name":"Augmentation cheek bone","description":"Malar augmentation, prosthetic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":841.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0276","name":"Pild/placebo control clin tr","description":"Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72052","name":"X-ray exam neck spine 6/>vws","description":"Radiologic examination, spine, cervical; 6 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28297","name":"Cor hlx vlgs jt arthrd","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70336","name":"Magnetic image jaw joint","description":"Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27337","name":"Exc thigh/knee les sc 3 cm/>","description":"Excision, tumor, soft tissue of thigh or knee area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8480","name":"Pros sock single ply ak","description":"Prosthetic sock, single ply, fitting, above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00126","name":"Anes px ear tympanotomy","description":"Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5695","name":"Ak sleeve susp neoprene/equa","description":"Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43886","name":"Gstr rstcv px opn revj port","description":"Gastric restrictive procedure, open; revision of subcutaneous port component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11200","name":"Rmvl skin tags up to&inc 15","description":"Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65114","name":"Remove eye/revise socket","description":"Exenteration of orbit (does not include skin graft), removal of orbital contents; with muscle or myocutaneous flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75756","name":"Artery x-rays chest","description":"Angiography, internal mammary, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2607","name":"Skin pro/pos wc cus wd <22in","description":"Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87086","name":"Urine culture/colony count","description":"Culture, bacterial; quantitative colony count, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6628","name":"Quick disconn hook adapter o","description":"Upper extremity addition, quick disconnect hook adapter, otto bock or equal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6215","name":"Foam dressing wound filler","description":"Foam dressing, wound filler, sterile, per gram","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61566","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for selective amygdalohippocampectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0515T","name":"Insj wcs lv compl sys","description":"Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; complete system (includes electrode and generator [transmitter and battery])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95706","name":"Eeg wo vid 2-12hr intmt mntr","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, 2-12 hours; with intermittent monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77333","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45562","name":"Exploration/repair of rectum","description":"Exploration, repair, and presacral drainage for rectal injury;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6441","name":"Pad band w>=3in <5in/yd","description":"Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6403","name":"Sterile gauze>16 <= 48 sq in","description":"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77012","name":"Ct scan for needle biopsy","description":"Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92340","name":"Fit spectacles monofocal","description":"Fitting of spectacles, except for aphakia; monofocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80050","name":"General health panel","description":"General health panel this panel must include the following: comprehensive metabolic panel (80053) 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 (85","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24925","name":"Amputation follow-up surgery","description":"Amputation, arm through humerus; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86334","name":"Immunofix e-phoresis serum","description":"Immunofixation electrophoresis; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73030","name":"X-ray exam of shoulder","description":"Radiologic examination, shoulder; complete, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5611","name":"Ak 4 bar link w/fric swing","description":"Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":799.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33710","name":"Repair of heart defects","description":"Repair sinus of valsalva fistula, with cardiopulmonary bypass; with repair of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1784.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95803","name":"Actigraphy testing","description":"Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33210","name":"Insert electrd/pm cath sngl","description":"Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92083","name":"Extended visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 deg, or quantitative, automated threshold perimetry, octopus program g-1, 32 or 42, hump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33802","name":"Division aberrant vessel","description":"Division of aberrant vessel (vascular ring);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78701","name":"Kidney imaging with flow","description":"Kidney imaging morphology; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0442T","name":"Abltj perc plex/trncl nrv","description":"Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40814","name":"Excise/repair mouth lesion","description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78264","name":"Gastric emptying img study","description":"Gastric emptying imaging study (eg, solid, liquid, or both);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38213","name":"Platelet deplete of harvest","description":"Transplant preparation of hematopoietic progenitor cells; platelet depletion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83704","name":"Lipoprotein bld quan part","description":"Lipoprotein, blood; quantitation of lipoprotein particle number(s) (eg, by nuclear magnetic resonance spectroscopy), includes lipoprotein particle subclass(es), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84591","name":"Assay of nos vitamin","description":"Vitamin, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86652","name":"Encephaltis east eqne anbdy","description":"Antibody; encephalitis, eastern equine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8485","name":"Pros sock single ply upper l","description":"Prosthetic sock, single ply, fitting, upper limb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78445","name":"Vascular flow imaging","description":"Non-cardiac vascular flow imaging (ie, angiography, venography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93225","name":"Xtrnl ecg rec<48 hrs rec","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84106","name":"Test for porphobilinogen","description":"Porphobilinogen, urine; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44404","name":"Colonoscopy w/injection","description":"Colonoscopy through stoma; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36831","name":"Open thrombect av fistula","description":"Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70390","name":"X-ray exam of salivary duct","description":"Sialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37234","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1942.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85555","name":"Rbc osmotic fragility","description":"Osmotic fragility, rbc; unincubated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43193","name":"Esophagoscp rig trnso biopsy","description":"Esophagoscopy, rigid, transoral; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66820","name":"Incision secondary cataract","description":"Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (ziegler or wheeler knife)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3380","name":"Shoe clubfoot wedge","description":"Clubfoot wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55870","name":"Electroejaculation","description":"Electroejaculation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59136","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99494","name":"1st/sbsq psyc collab care","description":"Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (list separa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27842","name":"Treat ankle dislocation","description":"Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93790","name":"Ambl bp mntr w/sw i&r","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; review with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4103","name":"Ef ped fluid and electrolyte","description":"Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28496","name":"Treat big toe fracture","description":"Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":370.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33216","name":"Insert 1 electrode pm-defib","description":"Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53040","name":"Drainage of urethra abscess","description":"Drainage of deep periurethral abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66630","name":"Removal of iris","description":"Iridectomy, with corneoscleral or corneal section; sector for glaucoma (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22630","name":"Arthrd pst tq 1ntrspc lum","description":"Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57335","name":"Repair vagina","description":"Vaginoplasty for intersex state","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":750.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75827","name":"Vein x-ray chest","description":"Venography, caval, superior, with serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85610","name":"Prothrombin time","description":"Prothrombin time;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0484","name":"Monitor elec or comb vad rep","description":"Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1773.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8641","name":"Metatarsal joint implant","description":"Metatarsal joint implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28234","name":"Incision of foot tendon","description":"Tenotomy, open, extensor, foot or toe, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57109","name":"Vagnc bi total pel lymphadec","description":"Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95851","name":"Range of motion measurements","description":"Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92545","name":"Oscillating tracking test","description":"Oscillating tracking test, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51841","name":"Attach bladder/urethra","description":"Anterior vesicourethropexy, or urethropexy (eg, marshall-marchetti-krantz, burch); complicated (eg, secondary repair)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23412","name":"Repair rotator cuff chronic","description":"Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":720.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34715","name":"Opn ax/subcla art expos","description":"Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88239","name":"Tissue culture tumor","description":"Tissue culture for neoplastic disorders; solid tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23670","name":"Optx sho dislc fx","description":"Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6638","name":"Elec lock on manual pw elbow","description":"Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1218.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87850","name":"N. gonorrhoeae assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; neisseria gonorrhoeae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21725","name":"Revision of neck muscle","description":"Division of sternocleidomastoid for torticollis, open operation; with cast application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96131","name":"Psycl tst eval phys/qhp ea","description":"Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78020","name":"Thyroid met uptake","description":"Thyroid carcinoma metastases uptake (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69720","name":"Release facial nerve","description":"Decompression facial nerve, intratemporal; lateral to geniculate ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":963.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72081","name":"X-ray exam entire spi 1 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64491","name":"Inj paravert f jnt c/t 2 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), cervical or thoracic; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00920","name":"Anes px male genitalia nos","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24343","name":"Repr elbow lat ligmnt w/tiss","description":"Repair lateral collateral ligament, elbow, with local tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53240","name":"Surgery for urethra pouch","description":"Marsupialization of urethral diverticulum, male or female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23470","name":"Reconstruct shoulder joint","description":"Arthroplasty, glenohumeral joint; hemiarthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73551","name":"X-ray exam of femur 1","description":"Radiologic examination, femur; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6629","name":"Lamination collar w/ couplin","description":"Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26561","name":"Repair of web finger","description":"Repair of syndactyly (web finger) each web space; with skin flaps and grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":802.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4618","name":"Breathing circuits","description":"Breathing circuits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98943","name":"Chiropract manj xtrspinl 1/>","description":"Chiropractic manipulative treatment (cmt); extraspinal, 1 or more regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T5001","name":"Position seat spec orth need","description":"Positioning seat for persons with special orthopedic needs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33965","name":"Ecmo/ecls rmvl perph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44604","name":"Suture large intestine","description":"Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":875.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12036","name":"Intmd rpr s/a/t/ext 20.1-30","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99467","name":"Ped crit care transport addl","description":"Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; each additional 30 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6605","name":"Single pivot hinge pair","description":"Upper extremity additions, single pivot hinge, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32556","name":"Insert cath pleura w/o image","description":"Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":498.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27331","name":"Explore/treat knee joint","description":"Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":398.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25071","name":"Exc forearm les sc 3 cm/>","description":"Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35261","name":"Rpr blvsl grf oth/thn vn nck","description":"Repair blood vessel with graft other than vein; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":863.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35566","name":"Art byp fem-ant-post tib/prl","description":"Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery or other distal vessels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1474.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36215","name":"Place catheter in artery","description":"Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50080","name":"Perq nl/pl lithotrp smpl<2cm","description":"Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (eg, stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching ston","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":702.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84202","name":"Assay rbc protoporphyrin","description":"Protoporphyrin, rbc; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21034","name":"Excise max/zygoma mal tumor","description":"Excision of malignant tumor of maxilla or zygoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71555","name":"Mri angio chest w or w/o dye","description":"Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67320","name":"Revise eye muscle(s) add-on","description":"Transposition procedure (eg, for paretic extraocular muscle), any extraocular muscle (specify) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48000","name":"Drainage of abdomen","description":"Placement of drains, peripancreatic, for acute pancreatitis;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78006","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":191.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37197","name":"Remove intrvas foreign body","description":"Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1301.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49553","name":"Rpr fem hernia init blocked","description":"Repair initial femoral hernia, any age; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42280","name":"Preparation palate mold","description":"Maxillary impression for palatal prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80416","name":"Renin stimulation panel","description":"Renal vein renin stimulation panel (eg, captopril) this panel must include the following: renin (84244 x 6)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44186","name":"Lap jejunostomy","description":"Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74220","name":"X-ray xm esophagus 1cntrst","description":"Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31529","name":"Laryngoscopy and dilation","description":"Laryngoscopy direct, with or without tracheoscopy; with dilation, subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50430","name":"Njx px nfrosgrm &/urtrgrm","description":"Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21210","name":"Face bone graft","description":"Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1591.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97026","name":"Infrared therapy","description":"Application of a modality to 1 or more areas; infrared","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15201","name":"Fth/gft fr trnk each addl","description":"Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17270","name":"Dstr mal les s/n/h/f/g .5 /<","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21811","name":"Optx of rib fx w/fixj scope","description":"Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":515.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61559","name":"Excision of skull/sutures","description":"Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); recontouring with multiple osteotomies and bone autografts (eg, barrel-stave procedure) (includes obtaining grafts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2193.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70332","name":"X-ray exam of jaw joint","description":"Temporomandibular joint arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33925","name":"Rpr pul art unifocal w/o cpb","description":"Repair of pulmonary artery arborization anomalies by unifocalization; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43332","name":"Transab esoph hiat hern rpr","description":"Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":966.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82016","name":"Acylcarnitines qual","description":"Acylcarnitines; qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47539","name":"Perq plmt bile duct stent","description":"Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; new access,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3638.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53025","name":"Incision of urethra","description":"Meatotomy, cutting of meatus (separate procedure); infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75970","name":"Vascular biopsy","description":"Transcatheter biopsy, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61626","name":"Tcat perm occls/embol noncns","description":"Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), including all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention, percutaneous,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":747.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62256","name":"Remove brain cavity shunt","description":"Removal of complete cerebrospinal fluid shunt system; without replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95868","name":"Ndl emg cranial nrv musc bi","description":"Needle electromyography; cranial nerve supplied muscles, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28116","name":"Revision of foot","description":"Ostectomy, excision of tarsal coalition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":619.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84075","name":"Assay alkaline phosphatase","description":"Phosphatase, alkaline;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2606","name":"Position wc cush wdth>=22 in","description":"Positioning wheelchair seat cushion, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0870","name":"Tract frame attach footboard","description":"Traction frame, attached to footboard, extremity traction, (e.g., bucks)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26861","name":"Fusion of finger jnt add-on","description":"Arthrodesis, interphalangeal joint, with or without internal fixation; each additional interphalangeal joint (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68115","name":"Exc les conjunctiva >1 cm","description":"Excision of lesion, conjunctiva; over 1 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44900","name":"I&d appendix abscess open","description":"Incision and drainage of appendiceal abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":655.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89230","name":"Collect sweat for test","description":"Sweat collection by iontophoresis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5626","name":"Test socket hip disarticulat","description":"Addition to lower extremity, test socket, hip disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2840","name":"Tibial length sock fx or equ","description":"Addition to lower extremity orthosis, tibial length sock, fracture or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12031","name":"Intmd rpr s/a/t/ext 2.5 cm/<","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63035","name":"Lamot dcmprn nrv rt ea addl","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0503","name":"Battery pneum vad replacemnt","description":"Battery for pneumatic ventricular assist device, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20900","name":"Removal of bone for graft","description":"Bone graft, any donor area; minor or small (eg, dowel or button)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28008","name":"Incision of foot fascia","description":"Fasciotomy, foot and/or toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73660","name":"X-ray exam of toe(s)","description":"Radiologic examination; toe(s), minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35131","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, iliac artery (common, hypogastric, external)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4405","name":"Nonpectin based ostomy paste","description":"Ostomy skin barrier, non-pectin based, paste, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44121","name":"Removal of small intestine","description":"Enterectomy, resection of small intestine; each additional resection and anastomosis (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2210","name":"Lens sphcy bifocal 4.25-7/ov","description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78805","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83632","name":"Placental lactogen","description":"Lactogen, human placental (hpl) human chorionic somatomammotropin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75810","name":"Vein x-ray spleen/liver","description":"Splenoportography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93750","name":"Interrogation vad in person","description":"Interrogation of ventricular assist device (vad), in person, with physician or other qualified health care professional analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum status, recovery), with programming, if performe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26516","name":"Fusion of knuckle joint","description":"Capsulodesis, metacarpophalangeal joint; single digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84436","name":"Assay of total thyroxine","description":"Thyroxine; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33272","name":"Rmvl of subq defibrillator","description":"Removal of subcutaneous implantable defibrillator electrode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":298.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29540","name":"Strapping ankle &/foot","description":"Strapping; ankle and/or foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0282","name":"Elect stim wound care not pd","description":"Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4265","name":"Paraffin","description":"Paraffin, per pound","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67911","name":"Revise eyelid defect","description":"Correction of lid retraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":337.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35556","name":"Art byp grft fem-popliteal","description":"Bypass graft, with vein; femoral-popliteal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1233.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21034","name":"Excise max/zygoma mal tumor","description":"Excision of malignant tumor of maxilla or zygoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1057.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66225","name":"Repair/graft eye lesion","description":"Repair of scleral staphyloma with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29800","name":"Jaw arthroscopy/surgery","description":"Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36478","name":"Endovenous laser 1st vein","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5780","name":"Knee-shin pneum/hydra pneum","description":"Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP16","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2302","name":"Lens sphere trifocal 7.12-20","description":"Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0236T","name":"Trluml perip athrc abd aorta","description":"Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; abdominal aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88325","name":"Consltj compre rvw rec reprt","description":"Consultation, comprehensive, with review of records and specimens, with report on referred material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67924","name":"Repair eyelid defect","description":"Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51701","name":"Insert bladder catheter","description":"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42225","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate; attachment pharyngeal flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":776.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75563","name":"Card mri w/stress img & dye","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0605","name":"Repl batt lithium 4.5 v","description":"Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50546","name":"Laparoscopic nephrectomy","description":"Laparoscopy, surgical; nephrectomy, including partial ureterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":981.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2660","name":"Thoracic control thoracic ba","description":"Addition to lower extremity, thoracic control, thoracic band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27557","name":"Treat knee dislocation","description":"Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":888.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20970","name":"Bone/skin graft iliac crest","description":"Free osteocutaneous flap with microvascular anastomosis; iliac crest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2428.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46612","name":"Anoscopy remove lesions","description":"Anoscopy; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44370","name":"Small bowel endoscopy/stent","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with transendoscopic stent placement (includes predilation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45395","name":"Lap removal of rectum","description":"Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35521","name":"Art byp grft axill-femoral","description":"Bypass graft, with vein; axillary-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1082.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81204","name":"Ar gene charac alleles","description":"Ar (androgen receptor) (eg, spinal and bulbar muscular atrophy, kennedy disease, x chromosome inactivation) gene analysis; characterization of alleles (eg, expanded size or methylation status)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27889","name":"Ankle disarticulation","description":"Ankle disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0745","name":"Neuromuscular stim for shock","description":"Neuromuscular stimulator, electronic shock unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33722","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1414.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53215","name":"Removal of urethra","description":"Urethrectomy, total, including cystostomy; male","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0835","name":"Pwc gp2 std sing pow opt s/b","description":"Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27450","name":"Incision of thigh","description":"Osteotomy, femur, shaft or supracondylar; with fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":857.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34717","name":"Evasc rpr a-iliac ndgft","description":"Endovascular repair of iliac artery at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpret","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66184","name":"Revision of aqueous shunt","description":"Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":473.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24153","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":574.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87481","name":"Candida dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); candida species, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6250","name":"Elbow inter loc elbow forarm","description":"Above elbow, molded double wall socket, internal locking elbow, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22903","name":"Exc abd les sc 3 cm/>","description":"Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":378.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90901","name":"Biofeedback train any meth","description":"Biofeedback training by any modality","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58752","name":"Revise ovarian tube(s)","description":"Tubouterine implantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8507","name":"Trach-esoph voice pros pt in","description":"Tracheo-esophageal voice prosthesis, patient inserted, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45345","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28171","name":"Resect tarsal tumor","description":"Radical resection of tumor; tarsal (except talus or calcaneus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27560","name":"Treat kneecap dislocation","description":"Closed treatment of patellar dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":312.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55865","name":"Extensive prostate surgery","description":"Exposure of prostate, any approach, for insertion of radioactive substance; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1080.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45337","name":"Sigmoidoscopy & decompress","description":"Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0308T","name":"Insj ocular telescope prosth","description":"Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular lens prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0052","name":"Swingaway detach ftrest repl","description":"Swingaway, detachable footrests, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64642","name":"Chemodenerv 1 extremity 1-4","description":"Chemodenervation of one extremity; 1-4 muscle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87660","name":"Trichomonas vagin dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); trichomonas vaginalis, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46946","name":"Int hrhc lig 2+hroid w/o img","description":"Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups, without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80202","name":"Assay of vancomycin","description":"Vancomycin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0622","name":"Sio flex pelvisacral custom","description":"Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86320","name":"Serum immunoelectrophoresis","description":"Immunoelectrophoresis; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99357","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26686","name":"Treat hand dislocation","description":"Open treatment of carpometacarpal dislocation, other than thumb; complex, multiple, or delayed reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":526.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27395","name":"Lengthening of thigh tendons","description":"Lengthening of hamstring tendon; multiple tendons, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58670","name":"Laparoscopy tubal cautery","description":"Laparoscopy, surgical; with fulguration of oviducts (with or without transection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35492","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":382.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0168","name":"Wound closure by adhesive","description":"Wound closure utilizing tissue adhesive(s) only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25001","name":"Incise flexor carpi radialis","description":"Incision, flexor tendon sheath, wrist (eg, flexor carpi radialis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67904","name":"Repair eyelid defect","description":"Repair of blepharoptosis; (tarso) levator resection or advancement, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49020","name":"Drainage abdom abscess open","description":"Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0667","name":"Seg pneumatic appl full leg","description":"Segmental pneumatic appliance for use with pneumatic compressor, full leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2108","name":"Afo tib fx cast molded to pt","description":"Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12018","name":"Rpr f/e/e/n/l/m >30.0 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85300","name":"Antithrombin iii activity","description":"Clotting inhibitors or anticoagulants; antithrombin iii, activity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24365","name":"Reconstruct head of radius","description":"Arthroplasty, radial head;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46604","name":"Anoscopy and dilation","description":"Anoscopy; with dilation (eg, balloon, guide wire, bougie)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36836","name":"Prq av fstl crtj uxtr 1 acs","description":"Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiolo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5609.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88241","name":"Frozen cell preparation","description":"Thawing and expansion of frozen cells, each aliquot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61609","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":485.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27730","name":"Repair of tibia epiphysis","description":"Arrest, epiphyseal (epiphysiodesis), open; distal tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":494.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4313","name":"Catheter w/bag 3-way","description":"Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99447","name":"Ntrprof ph1/ntrnet/ehr 11-20","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patients treating/requesting physician or other qualified health care profess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69642","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1080.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2614","name":"Position back cush wd>=22in","description":"Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2180","name":"Plas shoe insert w ank joint","description":"Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35612","name":"Bpg subclavian-subclavian","description":"Bypass graft, with other than vein; subclavian-subclavian","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29305","name":"Appl hip spica cast 1 leg","description":"Application of hip spica cast; 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15952","name":"Exc trchntr pr ulc flp clsr","description":"Excision, trochanteric pressure ulcer, with skin flap closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21246","name":"Reconstruction of jaw","description":"Reconstruction of mandible or maxilla, subperiosteal implant; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":685.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87279","name":"Parainfluenza ag if","description":"Infectious agent antigen detection by immunofluorescent technique; parainfluenza virus, each type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0414","name":"Pelvic ring fx treat int fix","description":"Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27725","name":"Repair of lower leg","description":"Repair of nonunion or malunion, tibia; by synostosis, with fibula, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1028.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91117","name":"Colon motility 6 hr study","description":"Colon motility (manometric) study, minimum 6 hours continuous recording (including provocation tests, eg, meal, intracolonic balloon distension, pharmacologic agents, if performed), with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19283","name":"Perq dev breast 1st strtctc","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85244","name":"Clot factor viii reltd antgn","description":"Clotting; factor viii related antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86255","name":"Fluorescent antibody screen","description":"Fluorescent noninfectious agent antibody; screen, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81422","name":"Fetal chrmoml microdeltj","description":"Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, digeorge syndrome, cri-du-chat syndrome), circulating cell-free fetal dna in maternal blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27165","name":"Incision/fixation of femur","description":"Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0128","name":"Corf skilled nursing service","description":"Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27140","name":"Transplant femur ridge","description":"Osteotomy and transfer of greater trochanter of femur (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":756.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27606","name":"Incision of achilles tendon","description":"Tenotomy, percutaneous, achilles tendon (separate procedure); general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":229.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95813","name":"Eeg extnd mntr 61-119 min","description":"Electroencephalogram (eeg) extended monitoring; 61-119 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62268","name":"Drain spinal cord cyst","description":"Percutaneous aspiration, spinal cord cyst or syrinx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86593","name":"Syphilis test non-trep quant","description":"Syphilis test, non-treponemal antibody; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33947","name":"Ecmo/ecls initiation artery","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; initiation, veno-arterial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":296.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27257","name":"Treat hip dislocation","description":"Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; with manipulation, requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":305.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82024","name":"Assay of acth","description":"Adrenocorticotropic hormone (acth)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95079","name":"Ingest challenge addl 60 min","description":"Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); each additional 60 minutes of testing (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6219","name":"Gauze <= 16 sq in w/border","description":"Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5628","name":"Test socket hemipelvectomy","description":"Addition to lower extremity, test socket, hemipelvectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2510","name":"Th/wght bear quad-lat brim m","description":"Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24363","name":"Replace elbow joint","description":"Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43290","name":"Egd flx trnsorl dplmnt balo","description":"Esophagogastroduodenoscopy, flexible, transoral; with deployment of intragastric bariatric balloon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2062.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0092","name":"Set up port xray equipment","description":"Set-up portable x-ray equipment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27284","name":"Arthrodesis hip joint","description":"Arthrodesis, hip joint (including obtaining graft);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21480","name":"Cltx tmprmand dislc 1st/sbsq","description":"Closed treatment of temporomandibular dislocation; initial or subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52354","name":"Cystouretero w/biopsy","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85049","name":"Automated platelet count","description":"Blood count; platelet, automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1845","name":"Ko double upright pre cst","description":"Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a sp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":478.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23174","name":"Sqstrctmy humrl head srg nck","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43285","name":"Rmvl esophgl sphnctr dev","description":"Removal of esophageal sphincter augmentation device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":559.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75966","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99360","name":"Physician standby services","description":"Standby service, requiring prolonged attendance, each 30 minutes (eg, operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring eeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0239","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85027","name":"Complete cbc automated","description":"Blood count; complete (cbc), automated (hgb, hct, rbc, wbc and platelet count)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27303","name":"Drainage of bone lesion","description":"Incision, deep, with opening of bone cortex, femur or knee (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61343","name":"Crnec sopl crv lam dcmprn","description":"Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft (eg, arnold-chiari malformation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84078","name":"Assay alkaline phosphatase","description":"Phosphatase, alkaline; heat stable (total not included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27507","name":"Treatment of thigh fracture","description":"Open treatment of femoral shaft fracture with plate/screws, with or without cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0241U","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61480","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1752.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27888","name":"Amputation of foot at ankle","description":"Amputation, ankle, through malleoli of tibia and fibula (eg, syme, pirogoff type procedures), with plastic closure and resection of nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78814","name":"Pet image w/ct lmtd","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58957","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1008.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89235","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"S3819","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91020","name":"Gastric motility studies","description":"Gastric motility (manometric) studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70373","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87485","name":"Chlmyd pneum dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia pneumoniae, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92274","name":"Multifocal erg w/i&r","description":"Electroretinography (erg), with interpretation and report; multifocal (mferg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44345","name":"Revision of colostomy","description":"Revision of colostomy; complicated (reconstruction in-depth) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":858.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27428","name":"Reconstruction knee","description":"Ligamentous reconstruction (augmentation), knee; intra-articular (open)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31640","name":"Bronchoscopy w/tumor excise","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with excision of tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36558","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00932","name":"Anes male gent compl amp pns","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); complete amputation of penis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20950","name":"Mntr intrstitial fluid press","description":"Monitoring of interstitial fluid pressure (includes insertion of device, eg, wick catheter technique, needle manometer technique) in detection of muscle compartment syndrome","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46250","name":"Remove ext hem groups 2+","description":"Hemorrhoidectomy, external, 2 or more columns/groups","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":375.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11004","name":"Dbrdmt skin xtrnl gent&per","description":"Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4268","name":"Female condom","description":"Contraceptive supply, condom, female, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92551","name":"Pure tone hearing test air","description":"Screening test, pure tone, air only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37251","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10080","name":"I&d pilonidal cyst simple","description":"Incision and drainage of pilonidal cyst; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64771","name":"Sever cranial nerve","description":"Transection or avulsion of other cranial nerve, extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59514","name":"Cesarean delivery only","description":"Cesarean delivery only;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":815.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71120","name":"X-ray exam breastbone 2/>vws","description":"Radiologic examination; sternum, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61535","name":"Remove brain electrodes","description":"Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99492","name":"1st psyc collab care mgmt","description":"Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83898","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45390","name":"Colonoscopy w/resection","description":"Colonoscopy, flexible; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88291","name":"Cyto/molecular report","description":"Cytogenetics and molecular cytogenetics, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77084","name":"Mri bone marrow blood supply","description":"Magnetic resonance (eg, proton) imaging, bone marrow blood supply","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31295","name":"Nsl/sins ndsc surg max sins","description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1407.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36475","name":"Endovenous rf 1st vein","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":687.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92953","name":"Temporary external pacing","description":"Temporary transcutaneous pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93280","name":"Pm device progr eval dual","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37252","name":"Intrvasc us noncoronary 1st","description":"Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":585.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40819","name":"Excise lip or cheek fold","description":"Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49422","name":"Remove tunneled ip cath","description":"Removal of tunneled intraperitoneal catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95864","name":"Needle emg 4 extremities","description":"Needle electromyography; 4 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52700","name":"Drainage of prostate abscess","description":"Transurethral drainage of prostatic abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0163","name":"Commode chair with fixed arm","description":"Commode chair, mobile or stationary, with fixed arms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24515","name":"Optx humrl shft fx plate/scr","description":"Open treatment of humeral shaft fracture with plate/screws, with or without cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54830","name":"Remove epididymis lesion","description":"Excision of local lesion of epididymis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31825","name":"Repair of windpipe defect","description":"Surgical closure tracheostomy or fistula; with plastic repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67120","name":"Remove eye implant material","description":"Removal of implanted material, posterior segment; extraocular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92538","name":"Caloric vstblr test w/rec","description":"Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6550","name":"Neg pres wound ther drsg set","description":"Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58262","name":"Vag hyst including t/o","description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27165","name":"Incision/fixation of femur","description":"Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1161.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2088","name":"Off base opioid tx, add30","description":"Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44141","name":"Partial removal of colon","description":"Colectomy, partial; with skin level cecostomy or colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4349","name":"Disposable male external cat","description":"Male external catheter, with or without adhesive, disposable, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59841","name":"Induced abortion dilat&evac","description":"Induced abortion, by dilation and evacuation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32408","name":"Core ndl bx lng/med perq","description":"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85360","name":"Euglobulin lysis","description":"Euglobulin lysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01260","name":"Anes all px veins upper leg","description":"Anesthesia for all procedures involving veins of upper leg, including exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1310","name":"Post-operative body jacket","description":"Other scoliosis procedure, post-operative body jacket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2110","name":"Spherocylinder 4.25d/over 6d","description":"Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26910","name":"Amputate metacarpal bone","description":"Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46705","name":"Repair of anal stricture","description":"Anoplasty, plastic operation for stricture; infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92941","name":"Prq trlml revsc tot occl ami","description":"Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single major coronary artery and/or its branches or single bypass g","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":532.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84146","name":"Assay of prolactin","description":"Prolactin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00350","name":"Anes px major vsl neck nos","description":"Anesthesia for procedures on major vessels of neck; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21046","name":"Remove mandible cyst complex","description":"Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94621","name":"Cardiopulm exercise testing","description":"Cardiopulmonary exercise testing, including measurements of minute ventilation, co2 production, o2 uptake, and electrocardiographic recordings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28750","name":"Fusion of big toe joint","description":"Arthrodesis, great toe; metatarsophalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74450","name":"X-ray urethra/bladder","description":"Urethrocystography, retrograde, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0442","name":"Annual alcohol screen 15 min","description":"Annual alcohol misuse screening, 5 to 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88141","name":"Cytopath c/v interpret","description":"Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62322","name":"Njx interlaminar lmbr/sac","description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43113","name":"Removal of esophagus","description":"Total or near total esophagectomy, with thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3638.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27328","name":"Exc thigh/knee tum deep <5cm","description":"Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":530.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27511","name":"Treatment of thigh fracture","description":"Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4020","name":"Replace quadlat socket brim","description":"Replace quadrilateral socket brim, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":512.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72083","name":"X-ray exam entire spi 4/5 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 4 or 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38240","name":"Transplt allo hct/donor","description":"Hematopoietic progenitor cell (hpc); allogeneic transplantation per donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35371","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; common femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27295","name":"Amputation of leg at hip","description":"Disarticulation of hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66930","name":"Extraction of lens","description":"Removal of lens material; intracapsular, for dislocated lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57289","name":"Repair bladder & vagina","description":"Pereyra procedure, including anterior colporrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":500.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33405","name":"Replacement aortic valve opn","description":"Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5830","name":"Endo knee-shin pneum/swg pha","description":"Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1010.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0992","name":"Wheelchair solid seat insert","description":"Manual wheelchair accessory, solid seat insert","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26553","name":"Single transfer toe-hand","description":"Transfer, toe-to-hand with microvascular anastomosis; other than great toe, single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57282","name":"Colpopexy extraperitoneal","description":"Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":333.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46740","name":"Construction of absent anus","description":"Repair of high imperforate anus with rectourethral or rectovaginal fistula; perineal or sacroperineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1798.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28308","name":"Incision of metatarsal","description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":463.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88738","name":"Hgb quant transcutaneous","description":"Hemoglobin (hgb), quantitative, transcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42140","name":"Excision of uvula","description":"Uvulectomy, excision of uvula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":218.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33523","name":"Cabg art-vein six or more","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78282","name":"Gi protein loss","description":"Gastrointestinal protein loss","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86141","name":"C-reactive protein hs","description":"C-reactive protein; high sensitivity (hscrp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15789","name":"Chemical peel facial dermal","description":"Chemical peel, facial; dermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76977","name":"Us bone density measure","description":"Ultrasound bone density measurement and interpretation, peripheral site(s), any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84560","name":"Assay of urine/uric acid","description":"Uric acid; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83993","name":"Assay for calprotectin fecal","description":"Calprotectin, fecal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37500","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":556.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92201","name":"Opscpy extnd rta draw uni/bi","description":"Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31525","name":"Dx laryngoscopy excl nb","description":"Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31641","name":"Bronchoscopy treat blockage","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision (eg, laser therapy, cryotherapy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95885","name":"Musc tst done w/nerv tst lim","description":"Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79403","name":"Hematopoietic nuclear tx","description":"Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50435","name":"Exchange nephrostomy cath","description":"Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61567","name":"Incision of brain tissue","description":"Craniotomy with elevation of bone flap; for multiple subpial transections, with electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2349.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2280","name":"Molded inner boot","description":"Addition to lower extremity, molded inner boot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":243.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80503","name":"Path clin consltj sf 5-20","description":"Pathology clinical consultation; for a clinical problem, with limited review of patients history and medical records and straightforward medical decision making when using time for code selection, 5-20 minutes of total time is spent on the date of the consultation.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83664","name":"Lamellar bdy fetal lung","description":"Fetal lung maturity assessment; lamellar body density","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61606","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; intradural, including dural repair, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2620.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29843","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; for infection, lavage and drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78812","name":"Pet image skull-thigh","description":"Positron emission tomography (pet) imaging; skull base to mid-thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88148","name":"Cytopath c/v auto rescreen","description":"Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97161","name":"Pt eval low complex 20 min","description":"Physical therapy evaluation: low complexity, requiring these components: a history with no personal factors and/or comorbidities that impact the plan of care; an examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0601","name":"Repl batt silver oxide 1.5 v","description":"Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83630","name":"Lactoferrin fecal (qual)","description":"Lactoferrin, fecal; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49321","name":"Laparoscopy biopsy","description":"Laparoscopy, surgical; with biopsy (single or multiple)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":283.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99223","name":"1st hosp ip/obs high 75","description":"Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 75 minutes must","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92571","name":"Filtered speech test","description":"Filtered speech test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0235","name":"Paraffin bath unit portable","description":"Paraffin bath unit, portable (see medical supply code a4265 for paraffin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78464","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":241.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68850","name":"Injection for tear sac x-ray","description":"Injection of contrast medium for dacryocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3931","name":"Whfo nontorsion joint prefab","description":"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35515","name":"Art byp grft subclav-vertbrl","description":"Bypass graft, with vein; subclavian-vertebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6940","name":"Elbow disarticulation switch","description":"Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4614.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45123","name":"Partial proctectomy","description":"Proctectomy, partial, without anastomosis, perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35685","name":"Bypass graft patency/patch","description":"Placement of vein patch or cuff at distal anastomosis of bypass graft, synthetic conduit (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6442","name":"Conform band n/s w<3in/yd","description":"Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01432","name":"Anes px vn knee&pop av fstl","description":"Anesthesia for procedures on veins of knee and popliteal area; arteriovenous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57452","name":"Exam of cervix w/scope","description":"Colposcopy of the cervix including upper/adjacent vagina;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94003","name":"Vent mgmt inpat subq day","description":"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, each subsequent day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51703","name":"Insert bladder cath complex","description":"Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64508","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4726","name":"Dialys sol fld vol > 5999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69740","name":"Repair facial nerve","description":"Suture facial nerve, intratemporal, with or without graft or decompression; lateral to geniculate ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":940.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64722","name":"Decompression unspec nerve","description":"Decompression; unspecified nerve(s) (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":299.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4394","name":"Ostomy pouch liq deodorant","description":"Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54860","name":"Removal of epididymis","description":"Epididymectomy; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37237","name":"Open/perq place stent ea add","description":"Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":937.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69200","name":"Clear outer ear canal","description":"Removal foreign body from external auditory canal; without general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59409","name":"Obstetrical care","description":"Vaginal delivery only (with or without episiotomy and/or forceps);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":714.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47120","name":"Partial removal of liver","description":"Hepatectomy, resection of liver; partial lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32662","name":"Thoracoscopy w/mediast exc","description":"Thoracoscopy, surgical; with excision of mediastinal cyst, tumor, or mass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62360","name":"Insert spine infusion device","description":"Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22100","name":"Remove part of neck vertebra","description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65272","name":"Repair of eye wound","description":"Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89321","name":"Semen anal sperm detection","description":"Semen analysis; sperm presence and motility of sperm, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35459","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":463.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2755","name":"Carbon graphite lamination","description":"Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4340","name":"Indwelling catheter special","description":"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0473","name":"Group behave couns 2-10","description":"Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2260","name":"Reinforced solid stirrup","description":"Addition to lower extremity, reinforced solid stirrup (scott-craig type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86905","name":"Blood typing rbc antigens","description":"Blood typing, serologic; rbc antigens, other than abo or rh (d), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92567","name":"Tympanometry","description":"Tympanometry (impedance testing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68801","name":"Dilate tear duct opening","description":"Dilation of lacrimal punctum, with or without irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24066","name":"Biopsy arm/elbow soft tissue","description":"Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49505","name":"Prp i/hern init reduc >5 yr","description":"Repair initial inguinal hernia, age 5 years or older; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86696","name":"Herpes simplex type 2 test","description":"Antibody; herpes simplex, type 2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0419T","name":"Dstrj neurofibroma xtnsv","description":"Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); face, head and neck, greater than 50 neurofibromas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12004","name":"Rpr s/n/ax/gen/trk7.6-12.5cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38510","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, deep cervical node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":337.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45309","name":"Proctosigmoidoscopy removal","description":"Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99605","name":"Mtms by pharm np 15 min","description":"Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, new patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92961","name":"Cardioversion electric int","description":"Cardioversion, elective, electrical conversion of arrhythmia; internal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":262.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95926","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45335","name":"Sigmoidoscopy w/submuc inj","description":"Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88373","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0073","name":"Caster pin lock each","description":"Caster pin lock, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0165","name":"Commode chair with detacharm","description":"Commode chair, mobile or stationary, with detachable arms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4430","name":"Ost urine pch w b/bltin conv","description":"Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53445","name":"Insert uro/ves nck sphincter","description":"Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":610.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85260","name":"Clot factor x stuart-power","description":"Clotting; factor x (stuart-prower)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45120","name":"Removal of rectum","description":"Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with pull-through procedure and anastomosis (eg, swenson, duhamel, or soave type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1337.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61524","name":"Removal of brain lesion","description":"Craniectomy, infratentorial or posterior fossa; for excision or fenestration of cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1908.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76513","name":"Oph us dx ant sgm us uni/bi","description":"Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) b-scan or high resolution biomicroscopy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63280","name":"Bx/exc idrl spine lesn crvl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1938.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2513","name":"Contact lens extended wear","description":"Contact lens, gas permeable, extended wear, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12047","name":"Intmd rpr n-hf/genit >30.0cm","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":349.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3652","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21010","name":"Incision of jaw joint","description":"Arthrotomy, temporomandibular joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":596.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15005","name":"Wnd prep f/n/hf/g addl cm","description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each additional 100 sq cm, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58572","name":"Tlh uterus over 250 g","description":"Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87913","name":"Nfct agt gntyp alys sarscov2","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), mutation identification in targeted region(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70200","name":"X-ray exam of eye sockets","description":"Radiologic examination; orbits, complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33925","name":"Rpr pul art unifocal w/o cpb","description":"Repair of pulmonary artery arborization anomalies by unifocalization; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1494.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48551","name":"Prep donor pancreas","description":"Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and y-graft arterial anastomoses from iliac artery to superio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63662","name":"Remove spine eltrd plate","description":"Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2006","name":"Post-d/c h vst ext pt 20 m","description":"Brief (20 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facili","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0186","name":"Dstry eye lesn,fdr vssl tech","description":"Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75822","name":"Vein x-ray arms/legs","description":"Venography, extremity, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35681","name":"Composite byp grft pros&vein","description":"Bypass graft; composite, prosthetic and vein (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01190","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30903","name":"Control of nosebleed","description":"Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5984","name":"Endoskeletal axial rotation","description":"All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21423","name":"Optx palatal/max fx comp","description":"Open treatment of palatal or maxillary fracture (lefort i type); complicated (comminuted or involving cranial nerve foramina), multiple approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84449","name":"Assay of transcortin","description":"Transcortin (cortisol binding globulin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29131","name":"Appl finger splint dynamic","description":"Application of finger splint; dynamic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33141","name":"Heart tmr w/other procedure","description":"Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95978","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96103","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70360","name":"X-ray exam of neck","description":"Radiologic examination; neck, soft tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33641","name":"Repair heart septum defect","description":"Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or without patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1425.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35632","name":"Bpg ilio-celiac","description":"Bypass graft, with other than vein; ilio-celiac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0414","name":"Pelvic ring fx treat int fix","description":"Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":653.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95923","name":"Autonomic nrv syst funj test","description":"Testing of autonomic nervous system function; sudomotor, including 1 or more of the following: quantitative sudomotor axon reflex test (qsart), silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1160","name":"Wheelchair fixed arms","description":"Wheelchair, fixed full length arms, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43330","name":"Esophagomyotomy abdominal","description":"Esophagomyotomy (heller type); abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1119.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57455","name":"Biopsy of cervix w/scope","description":"Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82553","name":"Creatine mb fraction","description":"Creatine kinase (ck), (cpk); mb fraction only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2306","name":"Lens sphcyl trifocal 4.00/>6","description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20920","name":"Removal of fascia for graft","description":"Fascia lata graft; by stripper","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":319.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90966","name":"Esrd home pt serv p mo 20+","description":"End-stage renal disease (esrd) related services for home dialysis per full month, for patients 20 years of age and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88332","name":"Path consltj surg ea add blk","description":"Pathology consultation during surgery; each additional tissue block with frozen section(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25920","name":"Amputate hand at wrist","description":"Disarticulation through wrist;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":601.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23802","name":"Arthrd glenohumeral jt w/grf","description":"Arthrodesis, glenohumeral joint; with autogenous graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84153","name":"Assay of psa total","description":"Prostate specific antigen (psa); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99251","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93886","name":"Intracranial complete study","description":"Transcranial doppler study of the intracranial arteries; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94761","name":"N-invas ear/pls oximetry mlt","description":"Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25240","name":"Partial removal of ulna","description":"Excision distal ulna partial or complete (eg, darrach type or matched resection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8101","name":"Spacer with mask","description":"Holding chamber or spacer for use with an inhaler or nebulizer; with mask","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27392","name":"Incision of thigh tendons","description":"Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":601.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42826","name":"Removal of tonsils","description":"Tonsillectomy, primary or secondary; age 12 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99215","name":"Office o/p est hi 40 min","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 40 minutes must be met or ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21245","name":"Reconstruction of jaw","description":"Reconstruction of mandible or maxilla, subperiosteal implant; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":967.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3340","name":"Shoe wedge sach","description":"Heel wedge, sach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46744","name":"Repair of cloacal anomaly","description":"Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, sacroperineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2967.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6238","name":"Hydrocolld drg >16<=48 w/bdr","description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58240","name":"Removal of pelvis contents","description":"Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1854.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27177","name":"Treat slipped epiphysis","description":"Open treatment of slipped femoral epiphysis; single or multiple pinning or bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":942.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33265","name":"Ablate atria lmtd endo","description":"Endoscopy, surgical; operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure), without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93644","name":"Ep eval subq impl dfb","description":"Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28140","name":"Removal of metatarsal","description":"Metatarsectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45560","name":"Repair of rectocele","description":"Repair of rectocele (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33215","name":"Reposition pacing-defib lead","description":"Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93296","name":"Rem interrog evl pm/ids","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20933","name":"Hemicrt intrclry algrft prtl","description":"Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":545.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90875","name":"Psychophysiological therapy","description":"Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17272","name":"Dstr mal les s/n/h/f/g 1.1-2","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01274","name":"Anes px art fem art emblc","description":"Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery embolectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0106T","name":"Touch quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using touch pressure stimuli to assess large diameter sensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84146","name":"Assay of prolactin","description":"Prolactin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33710","name":"Repair of heart defects","description":"Repair sinus of valsalva fistula, with cardiopulmonary bypass; with repair of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6694","name":"Elbow socket ins use w/lock","description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44140","name":"Partial removal of colon","description":"Colectomy, partial; with anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1113.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01610","name":"Anes all px nrv musc sho&ax","description":"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82803","name":"Blood gases any combination","description":"Gases, blood, any combination of ph, pco2, po2, co2, hco3 (including calculated o2 saturation);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63650","name":"Implant neuroelectrodes","description":"Percutaneous implantation of neurostimulator electrode array, epidural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1536.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5676","name":"Bk knee joints single axis p","description":"Additions to lower extremity, below knee, knee joints, single axis, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66150","name":"Glaucoma surgery","description":"Fistulization of sclera for glaucoma; trephination with iridectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":528.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4270","name":"Disposable endoscope sheath","description":"Disposable endoscope sheath, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32482","name":"Bilobectomy","description":"Removal of lung, other than pneumonectomy; 2 lobes (bilobectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5684","name":"Bk fork strap","description":"Addition to lower extremity, below knee, fork strap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96113","name":"Devel tst phys/qhp ea addl","description":"Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31541","name":"Larynscop w/tumr exc + scope","description":"Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33426","name":"Repair of mitral valve","description":"Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2070.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2250","name":"Foot plate molded stirrup at","description":"Addition to lower extremity, foot plate, molded to patient model, stirrup attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27658","name":"Repair of leg tendon each","description":"Repair, flexor tendon, leg; primary, without graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35372","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; deep (profunda) femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":861.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21172","name":"Rcnst supr-lat orb rm&lw fhd","description":"Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1899.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2218","name":"Lens aniseikonic bifocal","description":"Aniseikonic, per lens, bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27100","name":"Transfer of abdominal muscle","description":"Transfer external oblique muscle to greater trochanter including fascial or tendon extension (graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94015","name":"Patient recorded spirometry","description":"Patient-initiated spirometric recording per 30-day period of time; recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90952","name":"Esrd serv 2-3 vsts p mo <2yr","description":"End-stage renal disease (esrd) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11960","name":"Insert tissue expander(s)","description":"Insertion of tissue expander(s) for other than breast, including subsequent expansion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32659","name":"Thoracoscopy w/sac drainage","description":"Thoracoscopy, surgical; with creation of pericardial window or partial resection of pericardial sac for drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6212","name":"Foam drg <=16 sq in w/border","description":"Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0488","name":"Tlso rigid lined pre one pie","description":"Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts g","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22846","name":"Insert spine fixation device","description":"Anterior instrumentation; 4 to 7 vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":682.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0668","name":"Seg pneumatic appl full arm","description":"Segmental pneumatic appliance for use with pneumatic compressor, full arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50010","name":"Renal exploration","description":"Renal exploration, not necessitating other specific procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3140","name":"Abduction rotation bar shoe","description":"Foot, abduction rotation bar, including shoes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41251","name":"Repair tongue laceration","description":"Repair of laceration 2.5 cm or less; posterior one-third of tongue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70350","name":"X-ray head for orthodontia","description":"Cephalogram, orthodontic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25671","name":"Perq skel fix rad/uln dislc","description":"Percutaneous skeletal fixation of distal radioulnar dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4236","name":"Silvr oxide batt glucose mon","description":"Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","KL","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53230","name":"Removal of urethra lesion","description":"Excision of urethral diverticulum (separate procedure); female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":495.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0490","name":"Emr pwr source elec vad, rep","description":"Emergency power source for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":342.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6910","name":"Hand restoration no fingers","description":"Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8460","name":"Camisole post-mast","description":"Camisole, post-mastectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75803","name":"Lymph vessel x-ray arms/legs","description":"Lymphangiography, extremity only, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73080","name":"X-ray exam of elbow","description":"Radiologic examination, elbow; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21040","name":"Excise mandible lesion","description":"Excision of benign tumor or cyst of mandible, by enucleation and/or curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19100","name":"Bx breast percut w/o image","description":"Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87906","name":"Nfct agt gntyp alys hiv1","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); hiv-1, other region (eg, integrase, fusion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92547","name":"Supplemental electrical test","description":"Use of vertical electrodes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22206","name":"Incis spine 3 column thorac","description":"Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2171.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1701","name":"Repl cushions for jaw motion","description":"Replacement cushions for jaw motion rehabilitation system, pkg. of 6","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4617","name":"Mouth piece","description":"Mouth piece","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20692","name":"Appl mltpln uni ext fixj sys","description":"Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, ilizarov, monticelli type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":933.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87798","name":"Detect agent nos dna amp","description":"Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; amplified probe technique, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94775","name":"Ped home apnea mntr att only","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitor attachment only (includes hook-up, initiation of recording and disconnection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01931","name":"Anes ivnt rad ntrhpt/prt crc","description":"Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intrahepatic or portal circulation (eg, transvenous intrahepatic portosystemic shunt[s] [tips])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64912","name":"Nrv rpr w/nrv algrft 1st","description":"Nerve repair; with nerve allograft, each nerve, first strand (cable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":780.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43264","name":"Ercp remove duct calculi","description":"Endoscopic retrograde cholangiopancreatography (ercp); with removal of calculi/debris from biliary/pancreatic duct(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":278.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00190","name":"Anes px facial b1/skull nos","description":"Anesthesia for procedures on facial bones or skull; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2321","name":"Hand interface joystick","description":"Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93609","name":"Intra-vntr mapg tchycar site","description":"Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":413.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70030","name":"X-ray eye for foreign body","description":"Radiologic examination, eye, for detection of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95715","name":"Veeg ea 12-26hr intmt mntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, each increment of 12-26 hours; with intermittent monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35694","name":"Art trnsposj subclav carotid","description":"Transposition and/or reimplantation; subclavian to carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61611","name":"Transect artery sinus","description":"Transection or ligation, carotid artery in petrous canal; without repair (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":434.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99411","name":"Preventive counseling group","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92145","name":"Corneal hysteresis deter","description":"Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36833","name":"Av fistula revision","description":"Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5966","name":"Hip flexible cover system","description":"Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42971","name":"Control nose/throat bleeding","description":"Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); complicated, requiring hospitalization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81422","name":"Fetal chrmoml microdeltj","description":"Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, digeorge syndrome, cri-du-chat syndrome), circulating cell-free fetal dna in maternal blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46916","name":"Cryosurgery anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":187.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95800","name":"Slp stdy unattended","description":"Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4269","name":"Spermicide","description":"Contraceptive supply, spermicide (e.g., foam, gel), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94260","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99382","name":"Init pm e/m new pat 1-4 yrs","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26567","name":"Correct finger deformity","description":"Osteotomy; phalanx of finger, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":576.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78466","name":"Heart infarct image","description":"Myocardial imaging, infarct avid, planar; qualitative or quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95120","name":"Immunotherapy one injection","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74455","name":"X-ray urethra/bladder","description":"Urethrocystography, voiding, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33746","name":"Tis cgen car anomal ea addl","description":"Transcatheter intracardiac shunt (tis) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80047","name":"Basic metablc pnl ionized ca","description":"Basic metabolic panel (calcium, ionized) this panel must include the following: calcium, ionized (82330) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) potassium (84132) sodium (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12054","name":"Intmd rpr face/mm 7.6-12.5cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57155","name":"Insert uteri tandem/ovoids","description":"Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63709","name":"Repair spinal fluid leakage","description":"Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":979.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7006","name":"Filtered nebulizer admin set","description":"Administration set, with small volume filtered pneumatic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5681","name":"Intl custm cong/latyp insert","description":"Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5964","name":"Above knee flex cover system","description":"Addition, endoskeletal system, above knee, flexible protective outer surface covering system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":506.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2700","name":"Balance lens","description":"Balance lens, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96154","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26045","name":"Release palm contracture","description":"Fasciotomy, palmar (eg, dupuytrens contracture); open, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67505","name":"Inject/treat eye socket","description":"Retrobulbar injection; alcohol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3265","name":"Plastazote sandal each","description":"Plastazote sandal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25650","name":"Cltx ulnar styloid fracture","description":"Closed treatment of ulnar styloid fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3700","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95972","name":"Alys cplx sp/pn npgt w/prgrm","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28344","name":"Repair extra toe(s)","description":"Reconstruction, toe(s); polydactyly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":341.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77615","name":"Hyperthermia ntrstl prb>5","description":"Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0105","name":"Iv hanger","description":"Iv hanger, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6550","name":"Shldr disar prosth tiss shap","description":"Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44372","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with placement of percutaneous jejunostomy tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2301","name":"Lens sphere trifocal 4.12-7.","description":"Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99374","name":"Home health care supervision","description":"Supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (eg, alzheimers facility) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94669","name":"Mechanical chest wall oscill","description":"Mechanical chest wall oscillation to facilitate lung function, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55831","name":"Removal of prostate","description":"Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); retropubic, subtotal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":765.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20240","name":"Bone biopsy open superficial","description":"Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27712","name":"Osteot mlt relignmt imed rod","description":"Osteotomy; multiple, with realignment on intramedullary rod (eg, sofield type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":931.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8505","name":"Artificial larynx, accessory","description":"Artificial larynx replacement battery / accessory, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64632","name":"N block inj common digit","description":"Destruction by neurolytic agent; plantar common digital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67218","name":"Treatment of retinal lesion","description":"Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; radiation by implantation of source (includes removal of source)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":833.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52500","name":"Trurl resection bladder neck","description":"Transurethral resection of bladder neck (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50405","name":"Revision of kidney/ureter","description":"Pyeloplasty (foley y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1128.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3207","name":"Hightop w/ supp/pronator jun","description":"Orthopedic shoe, hightop with supinator or pronator, junior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21139","name":"Rdctj forehead cntrg&setback","description":"Reduction forehead; contouring and setback of anterior frontal sinus wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88130","name":"Sex chromatin identification","description":"Sex chromatin identification; barr bodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3971","name":"Sewho cap design w/jnt(s) cf","description":"Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87116","name":"Mycobacteria culture","description":"Culture, tubercle or other acid-fast bacilli (eg, tb, afb, mycobacteria) any source, with isolation and presumptive identification of isolates","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58293","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":878.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93351","name":"Stress tte complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84704","name":"Hcg free betachain test","description":"Gonadotropin, chorionic (hcg); free beta chain","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87001","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93291","name":"Interrog dev eval scrms ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; subcutaneous cardiac rhythm monitor system, including heart rhythm derived data analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0180","name":"Md certification hha patient","description":"Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51701","name":"Insert bladder catheter","description":"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37191","name":"Ins endovas vena cava filtr","description":"Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41153","name":"Tongue mouth neck surgery","description":"Glossectomy; composite procedure with resection floor of mouth, with suprahyoid neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43328","name":"Esoph fundoplasty thor","description":"Esophagogastric fundoplasty partial or complete; thoracotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":932.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58520","name":"Repair of ruptured uterus","description":"Hysterorrhaphy, repair of ruptured uterus (nonobstetrical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87269","name":"Giardia ag if","description":"Infectious agent antigen detection by immunofluorescent technique; giardia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70498","name":"Ct angiography neck","description":"Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2082","name":"Visit esketamine 56m or less","description":"Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":460.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19125","name":"Excision breast lesion","description":"Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":366.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0675","name":"Pneumatic compression device","description":"Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35558","name":"Art byp grft fem-femoral","description":"Bypass graft, with vein; femoral-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1080.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0629","name":"Lso flex w/rigid stays cust","description":"Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78012","name":"Thyroid uptake measurement","description":"Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44369","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65110","name":"Removal of eye","description":"Exenteration of orbit (does not include skin graft), removal of orbital contents; only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4130","name":"Replace pretibial shell","description":"Replace pretibial shell","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5826","name":"Miniature knee joint","description":"Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1547.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31292","name":"Nsl/sins ndsc med/inf dcmprn","description":"Nasal/sinus endoscopy, surgical, with orbital decompression; medial or inferior wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24149","name":"Radical resection of elbow","description":"Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44316","name":"Devise bowel pouch","description":"Continent ileostomy (kock procedure) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1186.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92512","name":"Nasal function studies","description":"Nasal function studies (eg, rhinomanometry)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0202","name":"Phototherapy light w/ photom","description":"Phototherapy (bilirubin) light with photometer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41826","name":"Excision of gum lesion","description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; with simple repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72074","name":"X-ray exam thorac spine4/>vw","description":"Radiologic examination, spine; thoracic, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90845","name":"Psychoanalysis","description":"Psychoanalysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86316","name":"Immunoassay tumor other","description":"Immunoassay for tumor antigen, other antigen, quantitative (eg, ca 50, 72-4, 549), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80500","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34803","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1097.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5071","name":"Urinary pouch w/barrier","description":"Ostomy pouch, urinary; with barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5672","name":"Bk removable medial brim sus","description":"Addition to lower extremity, below knee, removable medial brim suspension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92583","name":"Select picture audiometry","description":"Select picture audiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90812","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58321","name":"Artificial insemination","description":"Artificial insemination; intra-cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85730","name":"Thromboplastin time partial","description":"Thromboplastin time, partial (ptt); plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4216","name":"Parenteral nutrition additiv","description":"Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27596","name":"Amputation follow-up surgery","description":"Amputation, thigh, through femur, any level; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83026","name":"Hemoglobin copper sulfate","description":"Hemoglobin; by copper sulfate method, non-automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27290","name":"Amputation of leg at hip","description":"Interpelviabdominal amputation (hindquarter amputation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1378.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4262","name":"Temporary tear duct plug","description":"Temporary, absorbable lacrimal duct implant, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5020","name":"Conformity evaluation","description":"Conformity evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27724","name":"Repair/graft of tibia","description":"Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1067.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84597","name":"Assay of vitamin k","description":"Vitamin k","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28436","name":"Prq skel fix talus fx w/mnpj","description":"Percutaneous skeletal fixation of talus fracture, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75726","name":"Artery x-rays abdomen","description":"Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93289","name":"Interrog device eval heart","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including anal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5301","name":"Bk mold socket sach ft endo","description":"Below knee, molded socket, shin, sach foot, endoskeletal system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2064","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85041","name":"Automated rbc count","description":"Blood count; red blood cell (rbc), automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1234","name":"Fld ped wc tltnspc w/o seat","description":"Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93312","name":"Echo transesophageal","description":"Echocardiography, transesophageal, real-time with image documentation (2d) (with or without m-mode recording); including probe placement, image acquisition, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96137","name":"Psycl/nrpsyc tst phy/qhp ea","description":"Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3904","name":"Whfo electric custom fitted","description":"Wrist hand finger orthosis, external powered, electric, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23200","name":"Radical rescj tumor clavicle","description":"Radical resection of tumor; clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1788","name":"Port, indwelling, imp","description":"Port, indwelling (implantable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":560.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83700","name":"Lipopro bld electrophoretic","description":"Lipoprotein, blood; electrophoretic separation and quantitation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74263","name":"Ct colonography screening","description":"Computed tomographic (ct) colonography, screening, including image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":596.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94200","name":"Lung function test (mbc/mvv)","description":"Maximum breathing capacity, maximal voluntary ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75984","name":"Xray control catheter change","description":"Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80436","name":"Metyrapone panel","description":"Metyrapone panel this panel must include the following: cortisol (82533 x 2) 11 deoxycortisol (82634 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43753","name":"Tx gastro intub w/asp","description":"Gastric intubation and aspiration(s) therapeutic, necessitating physicians skill (eg, for gastrointestinal hemorrhage), including lavage if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82150","name":"Assay of amylase","description":"Amylase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83919","name":"Organic acids qual each","description":"Organic acids; qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5105","name":"Plast socket jts/thgh lacer","description":"Below knee, plastic socket, joints and thigh lacer, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2100.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0470","name":"Rad w/o backup non-inv intfc","description":"Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61796","name":"Srs cranial lesion simple","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":921.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93308","name":"Tte f-up or lmtd","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88332","name":"Path consltj surg ea add blk","description":"Pathology consultation during surgery; each additional tissue block with frozen section(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99403","name":"Prev med cnsl indiv apprx 45","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83663","name":"Fluoro polarize fetal lung","description":"Fetal lung maturity assessment; fluorescence polarization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88380","name":"Microdissection laser","description":"Microdissection (ie, sample preparation of microscopically identified target); laser capture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8658","name":"Interphalangeal joint spacer","description":"Interphalangeal joint spacer, silicone or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67346","name":"Biopsy eye muscle","description":"Biopsy of extraocular muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15277","name":"Skn sub grft f/n/hf/g child","description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33251","name":"Ablate heart dysrhythm focus","description":"Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, wolff-parkinson-white, atrioventricular node re-entry), tract(s) and/or focus (foci); with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1412.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92612","name":"Endoscopy swallow (fees) vid","description":"Flexible endoscopic evaluation of swallowing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86710","name":"Influenza virus antibody","description":"Antibody; influenza virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93318","name":"Echo transesophageal intraop","description":"Echocardiography, transesophageal (tee) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22819","name":"Kyphectomy 3 or more","description":"Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0651","name":"Pneum compressor segmental","description":"Pneumatic compressor, segmental home model without calibrated gradient pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67332","name":"Rerevise eye muscles add-on","description":"Strabismus surgery on patient with scarring of extraocular muscles (eg, prior ocular injury, strabismus or retinal detachment surgery) or restrictive myopathy (eg, dysthyroid ophthalmopathy) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0277","name":"Hbot, full body chamber, 30m","description":"Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82370","name":"X-ray assay calculus","description":"Calculus; x-ray diffraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16020","name":"Dress/debrid p-thick burn s","description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56405","name":"I&d vulva/perineal abscess","description":"Incision and drainage of vulva or perineal abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33289","name":"Tcat impl wrls p-art prs snr","description":"Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiog","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":283.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5630","name":"Syme typ expandabl wall sckt","description":"Addition to lower extremity, symes type, expandable wall socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24495","name":"Decompression fasct forearm","description":"Decompression fasciotomy, forearm, with brachial artery exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5685","name":"Below knee sus/seal sleeve","description":"Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1010","name":"Ctlso axilla sling","description":"Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57522","name":"Conization of cervix","description":"Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51784","name":"Anal/urinary muscle study","description":"Electromyography studies (emg) of anal or urethral sphincter, other than needle, any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58600","name":"Division of fallopian tube","description":"Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01470","name":"Anes px nrv msc lw l/a/f nos","description":"Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59851","name":"Induced abortion 1+njx d&c","description":"Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":365.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97610","name":"Low frequency non-thermal us","description":"Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65850","name":"Trabeculotomy ab externo","description":"Trabeculotomy ab externo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93459","name":"L hrt art/grft angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter place","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1171.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50437","name":"Dilat xst trc new access rcs","description":"Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed; including new access into the renal collecting sys","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0432","name":"Eia hiv-1/hiv-2 screen","description":"Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21825","name":"Treat sternum fracture","description":"Open treatment of sternum fracture with or without skeletal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4338","name":"Indwelling catheter latex","description":"Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28160","name":"Partial removal of toe","description":"Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61312","name":"Crnec/crnot sttl xdrl/sdrl","description":"Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1902.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50955","name":"Ureter endoscopy & biopsy","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36482","name":"Endoven ther chem adhes 1st","description":"Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":950.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86708","name":"Hepatitis a antibody","description":"Hepatitis a antibody (haab)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90836","name":"Psytx w pt w e/m 45 min","description":"Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73092","name":"X-ray exam of arm infant","description":"Radiologic examination; upper extremity, infant, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2370","name":"Pwr wc dr wh motor/gear comb","description":"Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43631","name":"Removal of stomach partial","description":"Gastrectomy, partial, distal; with gastroduodenostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3670","name":"So acro/clav can web pre ots","description":"Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2220","name":"Solid propuls tire, repl, ea","description":"Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01969","name":"Anes c hyst flwg neuraxial","description":"Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23350","name":"Injection for shoulder x-ray","description":"Injection procedure for shoulder arthrography or enhanced ct/mri shoulder arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88349","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1850","name":"Ko swedish type pre ots","description":"Knee orthosis, swedish type, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0808","name":"Pov group 2 vhd 451-600 lbs","description":"Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00211","name":"Anes icr px crnec/crnot hmtm","description":"Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47380","name":"Open ablate liver tumor rf","description":"Ablation, open, of 1 or more liver tumor(s); radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1200.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4269","name":"Spermicide","description":"Contraceptive supply, spermicide (e.g., foam, gel), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5970","name":"Foot external keel sach foot","description":"All lower extremity prostheses, foot, external keel, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0629","name":"Lso flex w/rigid stays cust","description":"Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77402","name":"Radiation tx delivery lvl 1","description":"Radiation treatment delivery; level 1 (eg, single-electron field, multiple-electron fields, or 2d photons), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67917","name":"Repair eyelid defect","description":"Repair of ectropion; extensive (eg, tarsal strip operations)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21159","name":"Rcnst mdfc lfrtiii advm wo i","description":"Reconstruction midface, lefort iii (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without lefort i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84182","name":"Protein western blot test","description":"Protein; western blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92563","name":"Tone decay hearing test","description":"Tone decay test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76870","name":"Us exam scrotum","description":"Ultrasound, scrotum and contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13131","name":"Cmplx rpr f/c/c/m/n/ax/g/h/f","description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50329","name":"Prep renal graft/ureteral","description":"Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; ureteral anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82390","name":"Assay of ceruloplasmin","description":"Ceruloplasmin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84203","name":"Test rbc protoporphyrin","description":"Protoporphyrin, rbc; screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27690","name":"Revise lower leg tendon","description":"Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":524.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7366","name":"Battery chrgr 12 volt utah/e","description":"Battery charger, twelve volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":355.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81171","name":"Aff2 gen aly detc abnl allel","description":"Aff2 (alf transcription elongation factor 2 [fmr2]) (eg, fragile x intellectual disability 2 [fraxe]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11103","name":"Tangntl bx skin ea sep/addl","description":"Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42962","name":"Control throat bleeding","description":"Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); with secondary surgical intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44405","name":"Colonoscopy w/dilation","description":"Colonoscopy through stoma; with transendoscopic balloon dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84490","name":"Assay of feces for trypsin","description":"Trypsin; feces, quantitative, 24-hour collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6235","name":"Hydrocolld drg >16<=48 w/o b","description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95724","name":"Eeg phy/qhp>60<84 hr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 60 hours, up to 84 hours of eeg recording, with video (veeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0486","name":"Mon cable elec/pneum vad rep","description":"Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6024","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":335.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01960","name":"Anes vaginal delivery only","description":"Anesthesia for vaginal delivery only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53430","name":"Reconstruction of urethra","description":"Urethroplasty, reconstruction of female urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":793.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88346","name":"Imfluor 1st 1antb stain px","description":"Immunofluorescence, per specimen; initial single antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29827","name":"Sho arthrs srg rt8tr cuf rpr","description":"Arthroscopy, shoulder, surgical; with rotator cuff repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64418","name":"Njx aa&/strd sprscap nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; suprascapular nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93226","name":"Xtrnl ecg rec<48 hr scan a/r","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44626","name":"Repair bowel opening","description":"Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of hartmann type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1321.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0980","name":"Wheelchair safety vest","description":"Safety vest, wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5062","name":"Drnble ostomy pouch w/o barr","description":"Ostomy pouch, drainable; without barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8691","name":"Aoi snd proc repl excl actua","description":"Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25825","name":"Arthrd wrist with autograft","description":"Arthrodesis, wrist; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":645.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35525","name":"Art byp grft brachial-brchl","description":"Bypass graft, with vein; brachial-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95961","name":"Electrode stimulation brain","description":"Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20250","name":"Biopsy vrt bdy open thoracic","description":"Biopsy, vertebral body, open; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6259","name":"Transparent film > 48 sq in","description":"Transparent film, sterile, more than 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59812","name":"Treatment of miscarriage","description":"Treatment of incomplete abortion, any trimester, completed surgically","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":298.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78452","name":"Ht muscle image spect mult","description":"Myocardial perfusion imaging, tomographic (spect) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or red","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77401","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93279","name":"Prgrmg dev eval pm/ldls pm","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94015","name":"Patient recorded spirometry","description":"Patient-initiated spirometric recording per 30-day period of time; recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4456","name":"Adhesive remover, wipes","description":"Adhesive remover, wipes, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77435","name":"Sbrt management","description":"Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69320","name":"Rebuild outer ear canal","description":"Reconstruction external auditory canal for congenital atresia, single stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47001","name":"Ndl biopsy lvr tm oth maj px","description":"Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83906","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4520","name":"Incontinence garment anytype","description":"Incontinence garment, any type, (e.g., brief, diaper), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8015","name":"Ext breastprosthesis garment","description":"External breast prosthesis garment, with mastectomy form, post mastectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96405","name":"Chemo intralesional up to 7","description":"Chemotherapy administration; intralesional, up to and including 7 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97811","name":"Acup 1/> w/o estim ea add 15","description":"Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with insertion of needle(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34701","name":"Evasc rpr a-ao ndgft","description":"Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1090.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91022","name":"Duodenal motility study","description":"Duodenal motility (manometric) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"R0075","name":"Transport port x-ray multipl","description":"Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87210","name":"Smear wet mount saline/ink","description":"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, india ink, koh preps)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51525","name":"Removal of bladder lesion","description":"Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":696.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91200","name":"Liver elastography","description":"Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74742","name":"X-ray fallopian tube","description":"Transcervical catheterization of fallopian tube, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86708","name":"Hepatitis a antibody","description":"Hepatitis a antibody (haab)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61343","name":"Crnec sopl crv lam dcmprn","description":"Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft (eg, arnold-chiari malformation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2008.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28072","name":"Removal of foot joint lining","description":"Synovectomy; metatarsophalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":396.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4772","name":"Blood glucose test strips","description":"Blood glucose test strips, for dialysis, per 50","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31637","name":"Bronchoscopy stent add-on","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; each additional major bronchus stented (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84550","name":"Assay of blood/uric acid","description":"Uric acid; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4030","name":"Replace socket brim cust fit","description":"Replace quadrilateral socket brim, custom fitted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96133","name":"Nrpsyc tst eval phys/qhp ea","description":"Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the pati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2386","name":"Foam filled drive wheel tire","description":"Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0270","name":"Mnt subs tx for change dx","description":"Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11201","name":"Rmvl skin tags ea addl 10","description":"Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23615","name":"Optx prox humrl fx w/int fix","description":"Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28106","name":"Remove/graft foot lesion","description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6223","name":"Gauze >16<=48 no w/sal w/o b","description":"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92521","name":"Evaluation of speech fluency","description":"Evaluation of speech fluency (eg, stuttering, cluttering)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73723","name":"Mri joint lwr extr w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83719","name":"Assay of blood lipoprotein","description":"Lipoprotein, direct measurement; vldl cholesterol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83918","name":"Organic acids total quant","description":"Organic acids; total, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4396","name":"Peristomal hernia supprt blt","description":"Ostomy belt with peristomal hernia support","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97150","name":"Group therapeutic procedures","description":"Therapeutic procedure(s), group (2 or more individuals)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26445","name":"Release hand/finger tendon","description":"Tenolysis, extensor tendon, hand or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0007","name":"Extra heavy duty wheelchair","description":"Extra heavy duty wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0105","name":"Cane adjust/fixed quad/3 pro","description":"Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33732","name":"Repair heart-vein defect","description":"Repair of cor triatriatum or supravalvular mitral ring by resection of left atrial membrane","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21244","name":"Reconstruction of lower jaw","description":"Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20694","name":"Rmvl ext fixj sys under anes","description":"Removal, under anesthesia, of external fixation system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70240","name":"X-ray exam pituitary saddle","description":"Radiologic examination, sella turcica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67255","name":"Reinforce/graft eye wall","description":"Scleral reinforcement (separate procedure); with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69005","name":"Drg xtrnl ear absc/hem comp","description":"Drainage external ear, abscess or hematoma; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43220","name":"Esophagoscopy balloon <30mm","description":"Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88112","name":"Cytopath cell enhance tech","description":"Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10160","name":"Pnxr aspir absc hmtma bulla","description":"Puncture aspiration of abscess, hematoma, bulla, or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5210","name":"No knee/ankle joints w/ ft b","description":"Above knee, short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75952","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":620.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53505","name":"Repair of urethra injury","description":"Urethrorrhaphy, suture of urethral wound or injury; penile","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59510","name":"Cesarean delivery","description":"Routine obstetric care including antepartum care, cesarean delivery, and postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2077.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20526","name":"Ther injection carp tunnel","description":"Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6006","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64492","name":"Inj paravert f jnt c/t 3 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), cervical or thoracic; third and any additional level(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93624","name":"Ep f-up study pacg&rec","description":"Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70100","name":"X-ray exam of jaw <4views","description":"Radiologic examination, mandible; partial, less than 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64643","name":"Chemodenerv 1 extrem 1-4 ea","description":"Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21244","name":"Reconstruction of lower jaw","description":"Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":828.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80162","name":"Assay of digoxin total","description":"Digoxin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49412","name":"Ins device for rt guide open","description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20985","name":"Cptr-asst dir ms px","description":"Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77081","name":"Dxa bone density appendiculr","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27325","name":"Neurectomy hamstring","description":"Neurectomy, hamstring muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":472.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0120","name":"Cerv flex n/adj foam pre ots","description":"Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8627","name":"Cid ext speech process repl","description":"Cochlear implant, external speech processor, component, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3479.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5050","name":"Ank symes mold sckt sach ft","description":"Ankle, symes, molded socket, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27036","name":"Capsulectomy/capsulotomy hip","description":"Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone, with release of hip flexor muscles (ie, gluteus medius, gluteus minimus, tensor fascia latae, rectus femoris, sartorius, iliopsoas)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1200","name":"Wheelchair amputee fixed arm","description":"Amputee wheelchair, fixed full length arms, swing away detachable footrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86603","name":"Adenovirus antibody","description":"Antibody; adenovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27438","name":"Revise kneecap with implant","description":"Arthroplasty, patella; with prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74160","name":"Ct abdomen w/contrast","description":"Computed tomography, abdomen; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6231","name":"Hydrogel dsg<=16 sq in","description":"Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80406","name":"Acth stimulation panel","description":"Acth stimulation panel; for 3 beta-hydroxydehydrogenase deficiency this panel must include the following: cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0602","name":"Manual breast pump","description":"Breast pump, manual, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44100","name":"Biopsy of bowel","description":"Biopsy of intestine by capsule, tube, peroral (1 or more specimens)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q4010","name":"Cast sup sht arm adult fbrgl","description":"Cast supplies, short arm cast, adult (11 years +), fiberglass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92608","name":"Ex for speech device rx addl","description":"Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B5200","name":"Parenteral sol hepatic fream","description":"Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress-branch chain amino acids-freamine-hbc-premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2718","name":"Fresnell prism press-on lens","description":"Press-on lens, fresnell prism, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17106","name":"Dstr cut vsc prlf les<10sqcm","description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5632","name":"Symes type ptb brim design s","description":"Addition to lower extremity, symes type, ptb brim design socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65101","name":"Removal of eye","description":"Enucleation of eye; without implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41520","name":"Reconstruction tongue fold","description":"Frenoplasty (surgical revision of frenum, eg, with z-plasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00102","name":"Anes px plstc rpr cleft lip","description":"Anesthesia for procedures involving plastic repair of cleft lip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86694","name":"Herpes simplex nes antbdy","description":"Antibody; herpes simplex, non-specific type test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83857","name":"Assay of methemalbumin","description":"Methemalbumin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78811","name":"Pet image ltd area","description":"Positron emission tomography (pet) imaging; limited area (eg, chest, head/neck)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37766","name":"Phleb veins - extrem 20+","description":"Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63078","name":"Spine disk surgery thorax","description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6665","name":"Teflon or equal cable lining","description":"Upper extremity addition, teflon, or equal, cable lining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42106","name":"Excision lesion mouth roof","description":"Excision, lesion of palate, uvula; with simple primary closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69662","name":"Revise middle ear bone","description":"Revision of stapedectomy or stapedotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92004","name":"Compre oph exam new pt 1/>","description":"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43845","name":"Gastroplasty duodenal switch","description":"Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1040","name":"Lumbar or lumbar rib pad","description":"Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30310","name":"Remove nasal foreign body","description":"Removal foreign body, intranasal; requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28645","name":"Repair toe dislocation","description":"Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":533.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84085","name":"Assay of rbc pg6d enzyme","description":"Phosphogluconate, 6-, dehydrogenase, rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33216","name":"Insert 1 electrode pm-defib","description":"Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64650","name":"Chemodenerv eccrine glands","description":"Chemodenervation of eccrine glands; both axillae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87197","name":"Serum bactericidal titer","description":"Serum bactericidal titer (schlichter test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61314","name":"Crnec/crnot ittl xdrl/sdrl","description":"Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1668.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36474","name":"Endovenous mchnchem add-on","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25628","name":"Optx carpl scphd fx int fixj","description":"Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":600.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95927","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78227","name":"Hepatobil syst image w/drug","description":"Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50328","name":"Prep renal graft/arterial","description":"Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; arterial anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64553","name":"Implant neuroelectrodes","description":"Percutaneous implantation of neurostimulator electrode array; cranial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73501","name":"X-ray exam hip uni 1 view","description":"Radiologic examination, hip, unilateral, with pelvis when performed; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93790","name":"Ambl bp mntr w/sw i&r","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; review with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51605","name":"Preparation for bladder xray","description":"Injection procedure and placement of chain for contrast and/or chain urethrocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72128","name":"Ct chest spine w/o dye","description":"Computed tomography, thoracic spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28531","name":"Treat sesamoid bone fracture","description":"Open treatment of sesamoid fracture, with or without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87230","name":"Toxin/antitoxin asy tiss cul","description":"Toxin or antitoxin assay, tissue culture (eg, clostridium difficile toxin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33814","name":"Obltrj a-pulm sep def w/byp","description":"Obliteration of aortopulmonary septal defect, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27425","name":"Lat retinacular release open","description":"Lateral retinacular release, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41009","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; masticator space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86829","name":"Hla class i/ii antibody qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to hla class i or class ii hla antigens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26485","name":"Transplant palm tendon","description":"Transfer or transplant of tendon, palmar; without free tendon graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28630","name":"Treat toe dislocation","description":"Closed treatment of metatarsophalangeal joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1894","name":"Intro/sheath, non-laser","description":"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51100","name":"Drain bladder by needle","description":"Aspiration of bladder; by needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33953","name":"Ecmo/ecls insj prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83014","name":"H pylori drug admin","description":"Helicobacter pylori; drug administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93292","name":"Wcd device interrogate","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47300","name":"Surgery for liver lesion","description":"Marsupialization of cyst or abscess of liver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99091","name":"Collj & interpj data ea 30 d","description":"Collection and interpretation of physiologic data (eg, ecg, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) r","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45339","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":255.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L1520","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1384.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35216","name":"Rpr blvsl dir ntrthrc wo byp","description":"Repair blood vessel, direct; intrathoracic, without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1799.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42836","name":"Removal of adenoids","description":"Adenoidectomy, secondary; age 12 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54001","name":"Slitting of prepuce","description":"Slitting of prepuce, dorsal or lateral (separate procedure); except newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90853","name":"Group psychotherapy","description":"Group psychotherapy (other than of a multiple-family group)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64740","name":"Incision of tongue nerve","description":"Transection or avulsion of; lingual nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88362","name":"Nerve teasing preparations","description":"Nerve teasing preparations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23190","name":"Ostectomy scapula partial","description":"Ostectomy of scapula, partial (eg, superior medial angle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63102","name":"Remove vert body dcmprn lmbr","description":"Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); lumbar, single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2003.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76945","name":"Echo guide villus sampling","description":"Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33933","name":"Prepare donor heart/lung","description":"Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, and trachea for implantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58700","name":"Removal of fallopian tube","description":"Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86310","name":"Heterophile antibody absrbj","description":"Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1015","name":"Shock absorber for man w/c","description":"Shock absorber for manual wheelchair, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23525","name":"Cltx strnclav dislc w/mnpj","description":"Closed treatment of sternoclavicular dislocation; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":325.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29860","name":"Hip arthroscopy dx","description":"Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93979","name":"Vascular study","description":"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0521T","name":"Interrog dev eval wcs ip","description":"Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording, and disconnection per patient encounter, wireless cardiac stimulator for left ventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27161","name":"Incision of neck of femur","description":"Osteotomy, femoral neck (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73140","name":"X-ray exam of finger(s)","description":"Radiologic examination, finger(s), minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90466","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92274","name":"Multifocal erg w/i&r","description":"Electroretinography (erg), with interpretation and report; multifocal (mferg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96417","name":"Chemo iv infus each addl seq","description":"Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86141","name":"C-reactive protein hs","description":"C-reactive protein; high sensitivity (hscrp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32552","name":"Remove lung catheter","description":"Removal of indwelling tunneled pleural catheter with cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64893","name":"Nrv grf 1strnd arm/leg >4 cm","description":"Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58100","name":"Biopsy of uterus lining","description":"Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74420","name":"Urography rtrgr +-kub","description":"Urography, retrograde, with or without kub","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2382","name":"Tube, pneum wheel drive tire","description":"Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92611","name":"Motion fluoroscopy/swallow","description":"Motion fluoroscopic evaluation of swallowing function by cine or video recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33222","name":"Relocation pocket pacemaker","description":"Relocation of skin pocket for pacemaker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3250","name":"Custom mold shoe remov prost","description":"Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25077","name":"Resect forearm/wrist tum<3cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":753.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0408","name":"Inpt/tele follow up 35","description":"Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59610","name":"Vbac delivery","description":"Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75887","name":"Vein x-ray liver w/o hemodyn","description":"Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67229","name":"Tr retinal les preterm inf","description":"Treatment of extensive or progressive retinopathy, 1 or more sessions, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (eg, retinopathy of prematurity), photocoagulation or cryotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":698.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33275","name":"Tcat rmvl perm ldls pm w/img","description":"Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":460.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4208","name":"3 cc sterile syringe&needle","description":"Syringe with needle, sterile 3 cc, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7012","name":"Nebulizer water collec devic","description":"Water collection device, used with large volume nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0157","name":"Walker crutch attachment","description":"Crutch attachment, walker, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01634","name":"Anes open/arthrs sho disrtcj","description":"Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; shoulder disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70470","name":"Ct head/brain w/o & w/dye","description":"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87149","name":"Dna/rna direct probe","description":"Culture, typing; identification by nucleic acid (dna or rna) probe, direct probe technique, per culture or isolate, each organism probed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36011","name":"Place catheter in vein","description":"Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28320","name":"Repair of foot bones","description":"Repair, nonunion or malunion; tarsal bones","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76513","name":"Oph us dx ant sgm us uni/bi","description":"Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) b-scan or high resolution biomicroscopy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26553","name":"Single transfer toe-hand","description":"Transfer, toe-to-hand with microvascular anastomosis; other than great toe, single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2772.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70220","name":"X-ray exam of sinuses","description":"Radiologic examination, sinuses, paranasal, complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29730","name":"Windowing of cast","description":"Windowing of cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88319","name":"Enzyme histochemistry","description":"Special stain including interpretation and report; group iii, for enzyme constituents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92588","name":"Evoked auditory tst complete","description":"Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24138","name":"Sequestrectomy olecrn proces","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":572.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49322","name":"Laparoscopy aspiration","description":"Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":306.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19328","name":"Rmvl intact breast implant","description":"Removal of intact breast implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4730","name":"Fistula cannulation set, ea","description":"Fistula cannulation set for hemodialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47711","name":"Excision of bile duct tumor","description":"Excision of bile duct tumor, with or without primary repair of bile duct; extrahepatic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26510","name":"Thumb tendon transfer","description":"Cross intrinsic transfer, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":509.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80420","name":"Dexamethasone panel","description":"Dexamethasone suppression panel, 48 hour this panel must include the following: free cortisol, urine (82530 x 2) cortisol (82533 x 2) volume measurement for timed collection (81050 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27324","name":"Biopsy thigh soft tissues","description":"Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31320","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":414.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50953","name":"Endoscopy of ureter","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94681","name":"O2 uptk co2 outp % o2 xtrc","description":"Oxygen uptake, expired gas analysis; including co2 output, percentage oxygen extracted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36420","name":"Venipuncture cutdown < 1 yr","description":"Venipuncture, cutdown; younger than age 1 year","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86828","name":"Hla class i&ii antibody qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to hla class i and class ii hla antigens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2861","name":"Torsion mechanism knee/ankle","description":"Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24420","name":"Osteoplasty humerus","description":"Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":862.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75573","name":"Ct hrt c+ strux cgen hrt ds","description":"Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3d image postprocessing, assessment of left ventricular [lv] cardiac function, right ventricular [rv] structure and function and evaluation of ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00730","name":"Anes px upper pst abdl wall","description":"Anesthesia for procedures on upper posterior abdominal wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0158","name":"Walker leg extenders set of4","description":"Leg extensions for walker, per set of four (4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86687","name":"Htlv-i antibody","description":"Antibody; htlv-i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92004","name":"Compre oph exam new pt 1/>","description":"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36410","name":"Vnpnxr 3yr/> phy/qhp dx/ther","description":"Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78261","name":"Gastric mucosa imaging","description":"Gastric mucosa imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33300","name":"Repair of heart wound","description":"Repair of cardiac wound; without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2136.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95148","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 4 single stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41115","name":"Excision of tongue fold","description":"Excision of lingual frenum (frenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93325","name":"Doppler echo color flow mapg","description":"Doppler echocardiography color flow velocity mapping (list separately in addition to codes for echocardiography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92352","name":"Fit aphakia spectcl monofocl","description":"Fitting of spectacle prosthesis for aphakia; monofocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33211","name":"Insert card electrodes dual","description":"Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12006","name":"Rpr s/n/a/gen/trk20.1-30.0cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95711","name":"Veeg 2-12 hr unmonitored","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, 2-12 hours; unmonitored","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63005","name":"Remove spine lamina 1/2 lmbr","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27768","name":"Cltx post ankle fx w/mnpj","description":"Closed treatment of posterior malleolus fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33954","name":"Ecmo/ecls insj prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75901","name":"Remove cva device obstruct","description":"Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32905","name":"Revise & repair chest wall","description":"Thoracoplasty, schede type or extrapleural (all stages);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51792","name":"Urinary reflex study","description":"Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95250","name":"Cont gluc mntr phys/qhp eqp","description":"Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and pr","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65750","name":"Corneal transplant","description":"Keratoplasty (corneal transplant); penetrating (in aphakia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0441T","name":"Abltj perc lxtr/perph nrv","description":"Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37761","name":"Ligate leg veins open","description":"Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01636","name":"Anes open/arthr ntrthrc amp","description":"Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0180","name":"Cer post col occ/man sup adj","description":"Cervical, multiple post collar, occipital/mandibular supports, adjustable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20816","name":"Replantation digit complete","description":"Replantation, digit, excluding thumb (includes metacarpophalangeal joint to insertion of flexor sublimis tendon), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1749.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20979","name":"Lw ntsty us stimj bone healg","description":"Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36903","name":"Intro cath dialysis circuit","description":"Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2565.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S0191","name":"Misoprostol, oral, 200 mcg","description":"Misoprostol, oral, 200 mcg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54055","name":"Destruction penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01404","name":"Anes opn/arthrs disrtcj knee","description":"Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5631","name":"Ak/knee disartic acrylic soc","description":"Addition to lower extremity, above knee or knee disarticulation, acrylic socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":291.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77022","name":"Mri gdn parnchyma tiss abltj","description":"Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":614.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92950","name":"Heart/lung resuscitation cpr","description":"Cardiopulmonary resuscitation (eg, in cardiac arrest)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48140","name":"Partial removal of pancreas","description":"Pancreatectomy, distal subtotal, with or without splenectomy; without pancreaticojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6688","name":"Frame typ sock above elb/dis","description":"Upper extremity addition, frame type socket, above elbow or elbow disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33422","name":"Revision of mitral valve","description":"Valvotomy, mitral valve; open heart, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43632","name":"Removal of stomach partial","description":"Gastrectomy, partial, distal; with gastrojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1704.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47000","name":"Needle biopsy of liver perq","description":"Biopsy of liver, needle; percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88364","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1720","name":"Legg perthes orthosis trilat","description":"Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88248","name":"Chromosome analysis 50-100","description":"Chromosome analysis for breakage syndromes; baseline breakage, score 50-100 cells, count 20 cells, 2 karyotypes (eg, for ataxia telangiectasia, fanconi anemia, fragile x)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0135","name":"Walker folding adjust/fixed","description":"Walker, folding (pickup), adjustable or fixed height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29907","name":"Subtalar arthro w/fusion","description":"Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58571","name":"Tlh w/t/o 250 g or less","description":"Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1161","name":"Manual adult wc w tiltinspac","description":"Manual adult size wheelchair, includes tilt in space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0457","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43238","name":"Egd us fine needle bx/aspir","description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80157","name":"Assay carbamazepine free","description":"Carbamazepine; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64483","name":"Njx aa&/strd tfrm epi l/s 1","description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or ct), lumbar or sacral, single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55840","name":"Extensive prostate surgery","description":"Prostatectomy, retropubic radical, with or without nerve sparing;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":947.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41145","name":"Tongue removal neck surgery","description":"Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2140.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01400","name":"Anes opn/arthrs knee jt nos","description":"Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61870","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1078.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67901","name":"Repair eyelid defect","description":"Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50240","name":"Nephrectomy partial","description":"Nephrectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82656","name":"El-1 fecal qual/semiq","description":"Elastase, pancreatic (el-1), fecal; qualitative or semi-quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63085","name":"Remove vert body dcmprn thrc","description":"Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58292","name":"Vag hyst t/o & repair compl","description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":845.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0476","name":"Hpv combo assay ca screen","description":"Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24935","name":"Revision of amputation","description":"Stump elongation, upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1003.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25023","name":"Decompress forearm 1 space","description":"Decompression fasciotomy, forearm and/or wrist, flexor or extensor compartment; with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1002.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2301","name":"Lens sphere trifocal 4.12-7.","description":"Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47011","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21146","name":"Rcnstj mdfc lefort i 2 w/grf","description":"Reconstruction midface, lefort i; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1301.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0521T","name":"Interrog dev eval wcs ip","description":"Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording, and disconnection per patient encounter, wireless cardiac stimulator for left ventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57280","name":"Suspension of vagina","description":"Colpopexy, abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78014","name":"Thyroid imaging w/blood flow","description":"Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78457","name":"Venous thrombosis imaging","description":"Venous thrombosis imaging, venogram; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93260","name":"Prgrmg dev eval impltbl sys","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31560","name":"Laryngoscop w/arytenoidectom","description":"Laryngoscopy, direct, operative, with arytenoidectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6023","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50951","name":"Endoscopy of ureter","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72270","name":"Myelogphy 2/> spine regions","description":"Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5960","name":"Endo hip ultra-light materia","description":"Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85014","name":"Hematocrit","description":"Blood count; hematocrit (hct)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92582","name":"Conditioning play audiometry","description":"Conditioning play audiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73706","name":"Ct angio lwr extr w/o&w/dye","description":"Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74182","name":"Mri abdomen w/contrast","description":"Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88307","name":"Tissue exam by pathologist","description":"Level v - surgical pathology, gross and microscopic examination adrenal, resection bone - biopsy/curettings bone fragment(s), pathologic fracture brain, biopsy brain/meninges, tumor resection breast, excision of lesion, requiring microscopic evaluation of surgical margins breast, mastectomy - partia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74301","name":"X-rays at surgery add-on","description":"Cholangiography and/or pancreatography; additional set intraoperative, radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28322","name":"Repair of metatarsals","description":"Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44397","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91011","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27412","name":"Autochondrocyte implant knee","description":"Autologous chondrocyte implantation, knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1398.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24079","name":"Rad rescj tum tiss a/e 5 cm+","description":"Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1135.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47525","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":396.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81329","name":"Smn1 gene dos/deletion alys","description":"Smn1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; dosage/deletion analysis (eg, carrier testing), includes smn2 (survival of motor neuron 2, centromeric) analysis, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92370","name":"Rpr&refitg spect xcp aphakia","description":"Repair and refitting spectacles; except for aphakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40761","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (abbe-estlander type), including sectioning and inserting of pedicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":870.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92607","name":"Ex for speech device rx 1hr","description":"Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44402","name":"Colonoscopy w/stent plcmt","description":"Colonoscopy through stoma; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93016","name":"Cv stress test supvj only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7520","name":"Repair prosthesis per 15 min","description":"Repair prosthetic device, labor component, per 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43243","name":"Egd injection varices","description":"Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64901","name":"Nerve graft add-on","description":"Nerve graft, each additional nerve; single strand (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81306","name":"Nudt15 gene common variants","description":"Nudt15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common variant(s) (eg, *2, *3, *4, *5, *6)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8041","name":"Midfacial prosthesis","description":"Midfacial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1632.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31633","name":"Bronchoscopy/needle bx addl","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24500","name":"Cltx humrl shft fx w/o mnpj","description":"Closed treatment of humeral shaft fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99172","name":"Ocular function screen","description":"Visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision (may include all or some screening of the determination[s] for contrast sensitivity, vision under glare)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72142","name":"Mri neck spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47600","name":"Cholecystectomy","description":"Cholecystectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":892.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90955","name":"Esrd srv 2-3 vsts p mo 2-11","description":"End-stage renal disease (esrd) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per mo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92576","name":"Synthetic sentence id test","description":"Synthetic sentence identification test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86361","name":"T cell absolute count","description":"T cells; absolute cd4 count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65855","name":"Trabeculoplasty laser surg","description":"Trabeculoplasty by laser surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96425","name":"Chemotherapy infusion method","description":"Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77414","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69662","name":"Revise middle ear bone","description":"Revision of stapedectomy or stapedotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":929.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41800","name":"Drainage of gum lesion","description":"Drainage of abscess, cyst, hematoma from dentoalveolar structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0199","name":"Dry pressure pad for mattres","description":"Dry pressure pad for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29125","name":"Appl short arm splint static","description":"Application of short arm splint (forearm to hand); static","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26474","name":"Fusion of finger tendons","description":"Tenodesis; of distal joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87076","name":"Culture anaerobe ident each","description":"Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4929","name":"Tourniquet for dialysis, ea","description":"Tourniquet for dialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87634","name":"Rsv dna/rna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); respiratory syncytial virus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28810","name":"Amputation toe & metatarsal","description":"Amputation, metatarsal, with toe, single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2383","name":"Insert, pneum wheel drive","description":"Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1951","name":"Afo spiral prefab custom","description":"Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0850","name":"Pwc gp 3 hd seat/back","description":"Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64792","name":"Removal of nerve lesion","description":"Excision of neurofibroma or neurolemmoma; extensive (including malignant type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40652","name":"Rpr lip fth<half ver height","description":"Repair lip, full thickness; up to half vertical height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67801","name":"Remove eyelid lesions","description":"Excision of chalazion; multiple, same lid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29806","name":"Sho arthrs srg capsulorraphy","description":"Arthroscopy, shoulder, surgical; capsulorrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":892.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29824","name":"Sho arthrs srg dstl claviclc","description":"Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (mumford procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29260","name":"Strapping of elbow or wrist","description":"Strapping; elbow or wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37241","name":"Vasc embolize/occlude venous","description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2458.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1250","name":"Anterior asis pad","description":"Addition to tlso, (low profile), anterior asis pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP20","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33140","name":"Heart revascularize (tmr)","description":"Transmyocardial laser revascularization, by thoracotomy; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1353.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4633","name":"Uvl replacement bulb","description":"Replacement bulb/lamp for ultraviolet light therapy system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27495","name":"Reinforce thigh","description":"Prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate, femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29895","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0251","name":"Hosp bed fixd ht w/o mattres","description":"Hospital bed, fixed height, with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43279","name":"Lap myotomy heller","description":"Laparoscopy, surgical, esophagomyotomy (heller type), with fundoplasty, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74185","name":"Mra abd w or w/o cntrst","description":"Magnetic resonance angiography, abdomen, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87086","name":"Urine culture/colony count","description":"Culture, bacterial; quantitative colony count, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00940","name":"Anes vaginal px nos","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36815","name":"Insertion of cannula","description":"Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external revision, or closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96904","name":"Whole body photography","description":"Whole body integumentary photography, for monitoring of high risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88272","name":"Cytogenetics 3-5","description":"Molecular cytogenetics; chromosomal in situ hybridization, analyze 3-5 cells (eg, for derivatives and markers)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36430","name":"Transfusion bld/bld compnt","description":"Transfusion, blood or blood components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82307","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72074","name":"X-ray exam thorac spine4/>vw","description":"Radiologic examination, spine; thoracic, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44408","name":"Colonoscopy w/decompression","description":"Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87332","name":"Cytomegalovirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; cytomegalovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64856","name":"Repair/transpose nerve","description":"Suture of major peripheral nerve, arm or leg, except sciatic; including transposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":851.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27702","name":"Reconstruct ankle joint","description":"Arthroplasty, ankle; with implant (total ankle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":808.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23415","name":"Release of shoulder ligament","description":"Coracoacromial ligament release, with or without acromioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6360","name":"Thoracic passive restor comp","description":"Interscapular thoracic, passive restoration (complete prosthesis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75980","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54660","name":"Revision of testis","description":"Insertion of testicular prosthesis (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4628","name":"Oropharyngeal suction cath","description":"Oral and/or oropharyngeal suction catheter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67801","name":"Remove eyelid lesions","description":"Excision of chalazion; multiple, same lid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0246","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11646","name":"Exc f/e/e/n/l mal+mrg >4 cm","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":319.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69955","name":"Release facial nerve","description":"Total facial nerve decompression and/or repair (may include graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1596.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3350","name":"Shoe heel wedge","description":"Heel wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4222","name":"Infusion supplies with pump","description":"Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96913","name":"Photochemotx sev dermatoses","description":"Photochemotherapy (goeckerman and/or puva) for severe photoresponsive dermatoses requiring at least 4-8 hours of care under direct supervision of the physician (includes application of medication and dressings)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0170","name":"Commode chair electric","description":"Commode chair with integrated seat lift mechanism, electric, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0020","name":"Fixed adjust armrest pair","description":"Fixed, adjustable height armrest, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75746","name":"Artery x-rays lung","description":"Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84132","name":"Assay of serum potassium","description":"Potassium; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99306","name":"1st nf care high mdm 50","description":"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 50 minutes must be met or exceed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86580","name":"Tb intradermal test","description":"Skin test; tuberculosis, intradermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0120","name":"Cerv flex n/adj foam pre ots","description":"Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58150","name":"Total hysterectomy","description":"Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0181","name":"Home health care supervision","description":"Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0944","name":"Pelvic belt/harness/boot","description":"Pelvic belt/harness/boot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69420","name":"Incision of eardrum","description":"Myringotomy including aspiration and/or eustachian tube inflation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20974","name":"Estim aid bone healg n-invas","description":"Electrical stimulation to aid bone healing; noninvasive (nonoperative)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64625","name":"Rf abltj nrv nrvtg si jt","description":"Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35510","name":"Art byp grft carotid-brchial","description":"Bypass graft, with vein; carotid-brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1085.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24220","name":"Injection px for elbow arthg","description":"Injection procedure for elbow arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42330","name":"Removal of salivary stone","description":"Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28525","name":"Treat toe fracture","description":"Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66830","name":"Removal of lens lesion","description":"Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86790","name":"Virus antibody nos","description":"Antibody; virus, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26670","name":"Treat hand dislocation","description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":285.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46083","name":"Inc thrombosed hroid xtrnl","description":"Incision of thrombosed hemorrhoid, external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36476","name":"Endovenous rf vein add-on","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28020","name":"Exploration of foot joint","description":"Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or tarsometatarsal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86703","name":"Hiv-1/hiv-2 1 result antbdy","description":"Antibody; hiv-1 and hiv-2, single result","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0221T","name":"Plmt post facet implt lumb","description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8043","name":"Upper facial prosthesis","description":"Upper facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","KM","95","93","NU","","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6022","name":"Collagen drsg>16<=48 sq in","description":"Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29902","name":"Mcp joint arthroscopy surg","description":"Arthroscopy, metacarpophalangeal joint, surgical; with reduction of displaced ulnar collateral ligament (eg, stener lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99235","name":"Hosp ip/obs same date mod 70","description":"Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encount","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6221","name":"Gauze > 48 sq in w/border","description":"Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1110","name":"Wheelchair semi-recl detach","description":"Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78215","name":"Lvr&spleen img static only","description":"Liver and spleen imaging; static only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57220","name":"Revision of urethra","description":"Plastic operation on urethral sphincter, vaginal approach (eg, kelly urethral plication)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93600","name":"Bundle of his recording","description":"Bundle of his recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67113","name":"Repair retinal detach cplx","description":"Repair of complex retinal detachment (eg, proliferative vitreoretinopathy, stage c-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, including, when performed, air, gas, or silicone oil tamp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":801.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5020","name":"Conformity evaluation","description":"Conformity evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45800","name":"Repair rect/bladder fistula","description":"Closure of rectovesical fistula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1059.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6250","name":"Skin seal protect moisturizr","description":"Skin sealants, protectants, moisturizers, ointments, any type, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1391","name":"Oxygen concentrator, dual","description":"Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47740","name":"Fuse gallbladder & bowel","description":"Cholecystoenterostomy; roux-en-y","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6196","name":"Alginate dressing <=16 sq in","description":"Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28606","name":"Treat foot dislocation","description":"Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0124","name":"Screen c/v thin layer by md","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95180","name":"Rapid desensitization","description":"Rapid desensitization procedure, each hour (eg, insulin, penicillin, equine serum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4395","name":"Ostomy pouch solid deodorant","description":"Ostomy deodorant for use in ostomy pouch, solid, per tablet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7190","name":"Elbow adolescent myoelectron","description":"Electronic elbow, adolescent, variety village or equal, myoelectronically controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0405","name":"Ekg interpret & report preve","description":"Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73500","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75562","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":714.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35566","name":"Art byp fem-ant-post tib/prl","description":"Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery or other distal vessels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44187","name":"Lap ileo/jejuno-stomy","description":"Laparoscopy, surgical; ileostomy or jejunostomy, non-tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99350","name":"Home/res vst est high mdm 60","description":"Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93295","name":"Dev interrog remote 1/2/mlt","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64417","name":"Njx aa&/strd ax nerve img","description":"Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3927","name":"Fo pip dip no jt spr pre ots","description":"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45342","name":"Sigmoidoscopy w/us guide bx","description":"Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0078","name":"Care manag h vst new pt 45 m","description":"Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47555","name":"Biliary endoscopy thru skin","description":"Biliary endoscopy, percutaneous via t-tube or other tract; with dilation of biliary duct stricture(s) without stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19366","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":909.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0966","name":"Wheelchair head rest extensi","description":"Manual wheelchair accessory, headrest extension, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27510","name":"Treatment of thigh fracture","description":"Closed treatment of femoral fracture, distal end, medial or lateral condyle, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42810","name":"Excision of neck cyst","description":"Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62351","name":"Implant spinal canal cath","description":"Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61543","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for partial or subtotal (functional) hemispherectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82340","name":"Assay of calcium in urine","description":"Calcium; urine quantitative, timed specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99173","name":"Visual acuity screen","description":"Screening test of visual acuity, quantitative, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32853","name":"Lung transplant double","description":"Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99308","name":"Sbsq nf care low mdm 20","description":"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 20 minutes must be met or exce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47564","name":"Laparo cholecystectomy/explr","description":"Laparoscopy, surgical; cholecystectomy with exploration of common duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1020","name":"Kyphosis pad","description":"Addition to ctlso or scoliosis orthosis, kyphosis pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2624","name":"Hip adj flex ext abduct cont","description":"Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4149","name":"Ef blenderized foods","description":"Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33203","name":"Insert epicard eltrd endo","description":"Insertion of epicardial electrode(s); endoscopic approach (eg, thoracoscopy, pericardioscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":698.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33286","name":"Rmvl subq car rhythm mntr","description":"Removal, subcutaneous cardiac rhythm monitor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33922","name":"Transect pulmonary artery","description":"Transection of pulmonary artery with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1205.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25931","name":"Amputation follow-up surgery","description":"Transmetacarpal amputation; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68115","name":"Exc les conjunctiva >1 cm","description":"Excision of lesion, conjunctiva; over 1 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92100","name":"Serial tonometry","description":"Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (eg, diurnal curve or medical treatment of acute elevation of intraocular pressure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49010","name":"Exploration behind abdomen","description":"Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72195","name":"Mri pelvis w/o dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93286","name":"Peri-px eval pm/ldls pm ip","description":"Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0710","name":"Ctlso a-p-l control w/ inter","description":"Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":977.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15366","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99484","name":"Care mgmt svc bhvl hlth cond","description":"Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of appli","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93893","name":"Tcd std icr art ven-art shnt","description":"Transcranial doppler study of the intracranial arteries; venous-arterial shunt detection with intravenous microbubble injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0005","name":"Alcohol and/or drug services","description":"Alcohol and/or drug services; group counseling by a clinician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22904","name":"Radical resect abd tumor<5cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0092","name":"Set up port xray equipment","description":"Set-up portable x-ray equipment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8689","name":"External recharg sys intern","description":"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26480","name":"Transplant hand tendon","description":"Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":631.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92352","name":"Fit aphakia spectcl monofocl","description":"Fitting of spectacle prosthesis for aphakia; monofocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77301","name":"Radiotherapy dose plan imrt","description":"Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4255","name":"Glucose monitor platforms","description":"Platforms for home blood glucose monitor, 50 per box","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33606","name":"Anastomosis/artery-aorta","description":"Anastomosis of pulmonary artery to aorta (damus-kaye-stansel procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39000","name":"Exploration of chest","description":"Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93571","name":"Iv dop vel&/press c flo 1st","description":"Intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, when performed; initial vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1831","name":"Knee orth pos locking joint","description":"Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59136","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":794.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0086","name":"Care man home care plan 30 m","description":"Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33690","name":"Banding pulmonary artery","description":"Banding of pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1038.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44204","name":"Laparo partial colectomy","description":"Laparoscopy, surgical; colectomy, partial, with anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23585","name":"Optx scapular fx w/int fixj","description":"Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86831","name":"Hla class ii phenotype qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); antibody identification by qualitative panel using complete hla phenotypes, hla class ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53661","name":"Dilation of urethra","description":"Dilation of female urethra including suppository and/or instillation; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34706","name":"Evasc rpr a-biiliac rpt","description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61650","name":"Evasc prlng admn rx agnt 1st","description":"Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85170","name":"Blood clot retraction","description":"Clot retraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01130","name":"Anes body cast appl/revj","description":"Anesthesia for body cast application or revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35460","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35226","name":"Repair blood vessel dir lxtr","description":"Repair blood vessel, direct; lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81309","name":"Pik3ca gene trgt seq alys","description":"Pik3ca (phosphatidylinositol-4, 5-biphosphate 3-kinase, catalytic subunit alpha) (eg, colorectal and breast cancer) gene analysis, targeted sequence analysis (eg, exons 7, 9, 20)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01958","name":"Anes xtrnl cephalic version","description":"Anesthesia for external cephalic version procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4020","name":"Replace quadlat socket brim","description":"Replace quadrilateral socket brim, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00210","name":"Anes intracranial px nos","description":"Anesthesia for intracranial procedures; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86310","name":"Heterophile antibody absrbj","description":"Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6243","name":"Hydrogel drg >16<=48 w/o bdr","description":"Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4530","name":"Ped size brief/diaper lg","description":"Pediatric sized disposable incontinence product, brief/diaper, large size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72120","name":"X-ray bend only l-s spine","description":"Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81345","name":"Tert gene targeted seq alys","description":"Tert (telomerase reverse transcriptase) (eg, thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (eg, promoter region)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43121","name":"Partial removal of esophagus","description":"Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without proximal gastrectomy, with thoracic esophagogastrostomy, with or without pyloroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2373.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47383","name":"Perq abltj lvr cryoablation","description":"Ablation, 1 or more liver tumor(s), percutaneous, cryoablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5288.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3252","name":"Shoe molded plastazote cust","description":"Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27435","name":"Incision of knee joint","description":"Capsulotomy, posterior capsular release, knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":683.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12055","name":"Intmd rpr face/mm 12.6-20 cm","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8428","name":"Ready gradient gauntlet","description":"Gradient pressure aid (gauntlet), ready made","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65093","name":"Revise eye with implant","description":"Evisceration of ocular contents; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20660","name":"Apply rem fixation device","description":"Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":216.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27350","name":"Removal of kneecap","description":"Patellectomy or hemipatellectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92584","name":"Electrocochleography","description":"Electrocochleography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94668","name":"Mnpj chest wall sbsq","description":"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1172","name":"Wheelchair amputee detach ar","description":"Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93618","name":"Indctj arrhythmia elec pacg","description":"Induction of arrhythmia by electrical pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":409.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43258","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67345","name":"Destroy nerve of eye muscle","description":"Chemodenervation of extraocular muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75736","name":"Artery x-rays pelvis","description":"Angiography, pelvic, selective or supraselective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62303","name":"Myelography lumbar injection","description":"Myelography via lumbar injection, including radiological supervision and interpretation; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78226","name":"Hepatobiliary system imaging","description":"Hepatobiliary system imaging, including gallbladder when present;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44135","name":"Intestine transplnt cadaver","description":"Intestinal allotransplantation; from cadaver donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1152.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31552","name":"Laryngoplasty laryngeal sten","description":"Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6925","name":"Wrist disart myoelectronic c","description":"Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60540","name":"Explore adrenal gland","description":"Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92002","name":"Intrm oph exam new patient","description":"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2204","name":"Lens sphcy bifocal 4.00d/2.1","description":"Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33545","name":"Repair of heart damage","description":"Repair of postinfarction ventricular septal defect, with or without myocardial resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2677.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27303","name":"Drainage of bone lesion","description":"Incision, deep, with opening of bone cortex, femur or knee (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":541.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54111","name":"Treat penis lesion graft","description":"Excision of penile plaque (peyronie disease); with graft to 5 cm in length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":647.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4608","name":"Transtracheal oxygen cath","description":"Transtracheal oxygen catheter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22630","name":"Arthrd pst tq 1ntrspc lum","description":"Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1412.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85397","name":"Clotting funct activity","description":"Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, adamts-13), each analyte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28890","name":"Hi enrgy eswt plantar fascia","description":"Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":256.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00790","name":"Anes iper upr abd nos","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2397","name":"Suspension sleeve lower ext","description":"Addition to lower extremity orthosis, suspension sleeve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27111","name":"Transfer of iliopsoas muscle","description":"Transfer iliopsoas; to femoral neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":762.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31526","name":"Dx laryngoscopy w/oper scope","description":"Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77525","name":"Proton treatment complex","description":"Proton treatment delivery; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0498T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0748","name":"Elec osteogen stim spinal","description":"Osteogenesis stimulator, electrical, non-invasive, spinal applications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43240","name":"Egd w/transmural drain cyst","description":"Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71111","name":"X-ray exam ribs/chest4/> vws","description":"Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5656","name":"Socket insert knee articulat","description":"Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82666","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77063","name":"Breast tomosynthesis bi","description":"Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35400","name":"Angioscopy","description":"Angioscopy (noncoronary vessels or grafts) during therapeutic intervention (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76510","name":"Oph us dx b-scan&quan a-scan","description":"Ophthalmic ultrasound, diagnostic; b-scan and quantitative a-scan performed during the same patient encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95870","name":"Ndl emg lmtd std musc 1 xtr","description":"Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45307","name":"Proctosigmoidoscopy fb","description":"Proctosigmoidoscopy, rigid; with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86788","name":"West nile virus ab igm","description":"Antibody; west nile virus, igm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3215","name":"Orthopedic ftwear ladies oxf","description":"Orthopedic footwear, ladies shoe, oxford, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52450","name":"Transurethral inc prostate","description":"Transurethral incision of prostate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0566T","name":"Autol cell implt adps njx","description":"Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0485T","name":"Oct mid ear i&r unilateral","description":"Optical coherence tomography (oct) of middle ear, with interpretation and report; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88264","name":"Chromosome analysis 20-25","description":"Chromosome analysis; analyze 20-25 cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2203","name":"Frame depth less than 22 in","description":"Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34847","name":"Visc & infraren abd 3 prosth","description":"Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2158.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6655","name":"Standard control cable extra","description":"Upper extremity addition, standard control cable, extra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41105","name":"Biopsy of tongue","description":"Biopsy of tongue; posterior one-third","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2522","name":"Cntct lens hydrophil bifocl","description":"Contact lens, hydrophilic, bifocal, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27495","name":"Reinforce thigh","description":"Prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate, femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":955.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5510","name":"Prep bk ptb plaster molded","description":"Preparatory, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":722.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87651","name":"Strep a dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); streptococcus, group a, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63250","name":"Revise spinal cord vsls crvl","description":"Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2742.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2136","name":"Kafo femoral fx cast rigid","description":"Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":734.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43226","name":"Esoph endoscopy dilation","description":"Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45327","name":"Proctosigmoidoscopy w/stent","description":"Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31050","name":"Exploration sphenoid sinus","description":"Sinusotomy, sphenoid, with or without biopsy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":372.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90968","name":"Esrd svc pr day pt 2-11","description":"End-stage renal disease (esrd) related services for dialysis less than a full month of service, per day; for patients 2-11 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6008","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50360","name":"Rnl altrnsplj w/o rcp nfrct","description":"Renal allotransplantation, implantation of graft; without recipient nephrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2105.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36580","name":"Replace cvad cath","description":"Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24110","name":"Exc/curtg b1 cst/b9 tum hum","description":"Excision or curettage of bone cyst or benign tumor, humerus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":493.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82530","name":"Cortisol free","description":"Cortisol; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92984","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01842","name":"Anes art farm wrst&hnd emblc","description":"Anesthesia for procedures on arteries of forearm, wrist, and hand; embolectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19085","name":"Bx breast 1st lesion mr imag","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":568.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73523","name":"X-ray exam hips bi 5/> views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70160","name":"X-ray exam of nasal bones","description":"Radiologic examination, nasal bones, complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44715","name":"Prepare donor intestine","description":"Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82003","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4332","name":"Lube sterile packet","description":"Lubricant, individual sterile packet, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87802","name":"Strep b assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; streptococcus, group b","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4412","name":"Ost pouch drain high output","description":"Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33321","name":"Repair major vessel","description":"Suture repair of aorta or great vessels; with shunt bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1027.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88107","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27712","name":"Osteot mlt relignmt imed rod","description":"Osteotomy; multiple, with realignment on intramedullary rod (eg, sofield type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41155","name":"Tongue jaw & neck surgery","description":"Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection (commando type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66920","name":"Extraction of lens","description":"Removal of lens material; intracapsular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56810","name":"Perineoplasty rpr per nonob","description":"Perineoplasty, repair of perineum, nonobstetrical (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73503","name":"X-ray exam hip uni 4/> views","description":"Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4338","name":"Indwelling catheter latex","description":"Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31420","name":"Epiglottidectomy","description":"Epiglottidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23334","name":"Shoulder prosthesis removal","description":"Removal of prosthesis, includes debridement and synovectomy when performed; humeral or glenoid component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31520","name":"Dx laryngoscopy newborn","description":"Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4036","name":"Enteral feed sup kit grav by","description":"Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77432","name":"Stereotactic radiation trmt","description":"Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":330.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23120","name":"Claviculectomy partial","description":"Claviculectomy; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75563","name":"Card mri w/stress img & dye","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0149","name":"Heavy duty wheeled walker","description":"Walker, heavy duty, wheeled, rigid or folding, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86294","name":"Immunoassay tumor qual","description":"Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62142","name":"Rmvl b1 flp/prostc plate skl","description":"Removal of bone flap or prosthetic plate of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":796.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5610","name":"Above knee hydracadence","description":"Addition to lower extremity, endoskeletal system, above knee, hydracadence system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70554","name":"Fmri brain by tech","description":"Magnetic resonance imaging, brain, functional mri; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85303","name":"Clot inhibit prot c activity","description":"Clotting inhibitors or anticoagulants; protein c, activity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0403","name":"Ekg for initial prevent exam","description":"Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54340","name":"Rpr hypspad comp simple","description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":461.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32405","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":294.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32606","name":"Thoracoscopy w/bx med space","description":"Thoracoscopy, diagnostic (separate procedure); mediastinal space, with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":370.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27244","name":"Treat thigh fracture","description":"Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1041.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4911","name":"Drain bag/bottle","description":"Drain bag/bottle, for dialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24300","name":"Mnpj elbow under anes","description":"Manipulation, elbow, under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93281","name":"Pm device progr eval multi","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2318","name":"Lens aniseikonic trifocal","description":"Aniseikonic lens, trifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4407","name":"Ext wear ost skn barr <=4sqin","description":"Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00406","name":"Anes integ sys rad brst dsj","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast with internal mammary node dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3915","name":"Who nontorsion jnts pre cst","description":"Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0971","name":"Wheelchair anti-tipping devi","description":"Manual wheelchair accessory, anti-tipping device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86704","name":"Hep b core antibody total","description":"Hepatitis b core antibody (hbcab); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8642","name":"Hallux implant","description":"Hallux implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63012","name":"Remove lamina/facets lumbar","description":"Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (gill type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1065.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25391","name":"Lengthen radius or ulna","description":"Osteoplasty, radius or ulna; lengthening with autograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":843.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32310","name":"Removal of chest lining","description":"Pleurectomy, parietal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":726.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0009","name":"Admin pneumococcal vaccine","description":"Administration of pneumococcal vaccine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32420","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88346","name":"Imfluor 1st 1antb stain px","description":"Immunofluorescence, per specimen; initial single antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70371","name":"Speech evaluation complex","description":"Complex dynamic pharyngeal and speech evaluation by cine or video recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81189","name":"Cstb gene full gene sequence","description":"Cstb (cystatin b) (eg, unverricht-lundborg disease) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23700","name":"Mnpj anes sho jt fixj aprats","description":"Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":164.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69840","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":722.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41822","name":"Excision of gum lesion","description":"Excision of fibrous tuberosities, dentoalveolar structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31626","name":"Bronchoscopy w/markers","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":622.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47135","name":"Transplantation of liver","description":"Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28585","name":"Repair foot dislocation","description":"Open treatment of talotarsal joint dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":700.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61576","name":"Skull base/brainstem surgery","description":"Transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion; requiring splitting of tongue and/or mandible (including tracheostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3832.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42960","name":"Control throat bleeding","description":"Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51101","name":"Drain bladder by trocar/cath","description":"Aspiration of bladder; by trocar or intracatheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27637","name":"Remove/graft leg bone lesion","description":"Excision or curettage of bone cyst or benign tumor, tibia or fibula; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":627.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80051","name":"Electrolyte panel","description":"Electrolyte panel this panel must include the following: carbon dioxide (bicarbonate) (82374) chloride (82435) potassium (84132) sodium (84295)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46615","name":"Anoscopy","description":"Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83874","name":"Assay of myoglobin","description":"Myoglobin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20251","name":"Biopsy vrt bdy open lmbr/crv","description":"Biopsy, vertebral body, open; lumbar or cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":374.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77054","name":"X-ray of mammary ducts","description":"Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0326","name":"Urinal female jug-type","description":"Urinal; female, jug-type, any material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28062","name":"Removal of foot fascia","description":"Fasciectomy, plantar fascia; radical (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":468.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72191","name":"Ct angiograph pelv w/o&w/dye","description":"Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36593","name":"Declot vascular device","description":"Declotting by thrombolytic agent of implanted vascular access device or catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0213T","name":"Njx paravert w/us cer/thor","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1225","name":"Manual semi-reclining back","description":"Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57305","name":"Repair rectum-vagina fistula","description":"Closure of rectovaginal fistula; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0112","name":"Cranial cervical orthosis","description":"Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":680.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20551","name":"Njx 1 tendon origin/insj","description":"Injection(s); single tendon origin/insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5672","name":"Bk removable medial brim sus","description":"Addition to lower extremity, below knee, removable medial brim suspension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4554","name":"Disposable underpads","description":"Disposable underpads, all sizes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30130","name":"Excise inferior turbinate","description":"Excision inferior turbinate, partial or complete, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":296.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93582","name":"Perq transcath closure pda","description":"Percutaneous transcatheter closure of patent ductus arteriosus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":712.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41114","name":"Excision of tongue lesion","description":"Excision of lesion of tongue with closure; with local tongue flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81596","name":"Nfct ds chrnc hcv 6 assays","description":"Infectious disease, chronic hepatitis c virus (hcv) infection, six biochemical assays (alt, a2-macroglobulin, apolipoprotein a-1, total bilirubin, ggt, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43755","name":"Dx gastr intub w/asp specs","description":"Gastric intubation and aspiration, diagnostic; collection of multiple fractional specimens with gastric stimulation, single or double lumen tube (gastric secretory study) (eg, histamine, insulin, pentagastrin, calcium, secretin), includes drug administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2624","name":"Adj skin pro/pos cus<22in","description":"Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70491","name":"Ct soft tissue neck w/dye","description":"Computed tomography, soft tissue neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01922","name":"Anes n-invas img/radj ther","description":"Anesthesia for non-invasive imaging or radiation therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45520","name":"Treatment of rectal prolapse","description":"Perirectal injection of sclerosing solution for prolapse","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9516","name":"Iodine i-123 sod iodide mic","description":"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25635","name":"Cltx carpl fx w/mnpj ea b1","description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); with manipulation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33736","name":"Revision of heart chamber","description":"Atrial septectomy or septostomy; open heart with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1218.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23076","name":"Exc shoulder tum deep < 5 cm","description":"Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":459.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75605","name":"Contrast exam thoracic aorta","description":"Aortography, thoracic, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52342","name":"Cysto w/up stricture tx","description":"Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17004","name":"Destroy premal lesions 15/>","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96931","name":"Rcm img acquisj&i&r 1st les","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15777","name":"Acellular derm matrix implt","description":"Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25107","name":"Remove wrist joint cartilage","description":"Arthrotomy, distal radioulnar joint including repair of triangular cartilage, complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":513.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42809","name":"Remove pharynx foreign body","description":"Removal of foreign body from pharynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76140","name":"X-ray consultation","description":"Consultation on x-ray examination made elsewhere, written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4087","name":"Gastro/jejuno tube, std","description":"Gastrostomy/jejunostomy tube, standard, any material, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78227","name":"Hepatobil syst image w/drug","description":"Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42340","name":"Removal of salivary stone","description":"Sialolithotomy; parotid, extraoral or complicated intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17263","name":"Dstrj mal les t/a/l 2.1-3.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0322","name":"Home h physio data collec tr","description":"The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47147","name":"Prep donor liver/arterial","description":"Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24579","name":"Optx humrl cndylr fracture","description":"Open treatment of humeral condylar fracture, medial or lateral, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69636","name":"Rebuild eardrum structures","description":"Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1115.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42720","name":"I&d absc phrngl ntraorl appr","description":"Incision and drainage abscess; retropharyngeal or parapharyngeal, intraoral approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57000","name":"Colpotomy w/exploration","description":"Colpotomy; with exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82375","name":"Assay carboxyhb quant","description":"Carboxyhemoglobin; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0967","name":"Man wc rim/projection rep ea","description":"Manual wheelchair accessory, hand rim with projections, any type, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86277","name":"Growth hormone antibody","description":"Growth hormone, human (hgh), antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11976","name":"Remove contraceptive capsule","description":"Removal, implantable contraceptive capsules","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88240","name":"Cell cryopreserve/storage","description":"Cryopreservation, freezing and storage of cells, each cell line","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1000","name":"Ctlso milwauke initial model","description":"Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84425","name":"Assay of vitamin b-1","description":"Thiamine (vitamin b-1)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91110","name":"Gi trc img intral esoph-ile","description":"Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":634.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21073","name":"Mnpj of tmj w/anesth","description":"Manipulation of temporomandibular joint(s) (tmj), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31646","name":"Brnchsc w/ther aspir sbsq","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital stay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67031","name":"Laser surgery eye strands","description":"Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (1 or more stages)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15220","name":"Fth/gft fr s/a/l 20 sq cm/<","description":"Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":480.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27603","name":"Drain lower leg lesion","description":"Incision and drainage, leg or ankle; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64784","name":"Remove nerve lesion","description":"Excision of neuroma; major peripheral nerve, except sciatic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23485","name":"Revision of collar bone","description":"Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":808.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45150","name":"Excision of rectal stricture","description":"Division of stricture of rectum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63305","name":"Remove vert idrl body thrc","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25375","name":"Revise radius & ulna","description":"Multiple osteotomies, with realignment on intramedullary rod (sofield type procedure); radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":808.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88269","name":"Chromosome analys amniotic","description":"Chromosome analysis, in situ for amniotic fluid cells, count cells from 6-12 colonies, 1 karyotype, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97113","name":"Aquatic therapy/exercises","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27122","name":"Reconstruction of hip socket","description":"Acetabuloplasty; resection, femoral head (eg, girdlestone procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46080","name":"Sphnctrotmy anal div sphnctr","description":"Sphincterotomy, anal, division of sphincter (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":214.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82777","name":"Galectin-3","description":"Galectin-3","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96542","name":"Chemotherapy injection","description":"Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40510","name":"Partial excision of lip","description":"Excision of lip; transverse wedge excision with primary closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":378.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37618","name":"Ligation major artery xtr","description":"Ligation, major artery (eg, post-traumatic, rupture); extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34703","name":"Evasc rpr a-unilac ndgft","description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1203.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73085","name":"Contrast x-ray of elbow","description":"Radiologic examination, elbow, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15260","name":"Fth/gft fr n/e/e/l 20 sqcm/<","description":"Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":615.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30000","name":"Drainage of nose lesion","description":"Drainage abscess or hematoma, nasal, internal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78305","name":"Bone imaging multiple areas","description":"Bone and/or joint imaging; multiple areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29823","name":"Sho arthrs srg xtnsv dbrdmt","description":"Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the ro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77407","name":"Radiation tx delivery lvl 2","description":"Radiation treatment delivery; level 2, single-isocenter (eg, 3d or imrt), photons, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21936","name":"Resect back tum 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1220.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43277","name":"Ercp ea duct/ampulla dilate","description":"Endoscopic retrograde cholangiopancreatography (ercp); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25530","name":"Cltx ulnar shft fx w/o mnpj","description":"Closed treatment of ulnar shaft fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00103","name":"Anes rcnstv px eyelid","description":"Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67840","name":"Remove eyelid lesion","description":"Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2358","name":"Gr 34 nonsealed leadacid","description":"Power wheelchair accessory, group 34 non-sealed lead acid battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59325","name":"Revision of cervix","description":"Cerclage of cervix, during pregnancy; abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92995","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":630.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15773","name":"Grfg autol fat lipo 25 cc/<","description":"Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":370.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81337","name":"Smn1 gen nown famil seq vrnt","description":"Smn1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; known familial sequence variant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66711","name":"Ecp ciliary body destruction","description":"Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91110","name":"Gi trc img intral esoph-ile","description":"Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5683","name":"Initial custom socket insert","description":"Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59840","name":"Induced abortion d&c","description":"Induced abortion, by dilation and curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":206.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4261","name":"Cervical cap contraceptive","description":"Cervical cap for contraceptive use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21601","name":"Exc chest wall tumor w/ribs","description":"Excision of chest wall tumor including rib(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21497","name":"Interdental wirg oth/thn fx","description":"Interdental wiring, for condition other than fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88166","name":"Cytopath tbs c/v auto redo","description":"Cytopathology, slides, cervical or vaginal (the bethesda system); with manual screening and computer-assisted rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0246","name":"Followup eval of foot pt lop","description":"Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41100","name":"Biopsy of tongue","description":"Biopsy of tongue; anterior two-thirds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65771","name":"Radial keratotomy","description":"Radial keratotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40806","name":"Incision of lip fold","description":"Incision of labial frenum (frenotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87385","name":"Histoplasma capsul ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; histoplasma capsulatum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66130","name":"Remove eye lesion","description":"Excision of lesion, sclera","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7191","name":"Elbow child myoelectronic ct","description":"Electronic elbow, child, variety village or equal, myoelectronically controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5603.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36595","name":"Mech remov tunneled cv cath","description":"Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78445","name":"Vascular flow imaging","description":"Non-cardiac vascular flow imaging (ie, angiography, venography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5671","name":"Bk/ak locking mechanism","description":"Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42600","name":"Closure of salivary fistula","description":"Closure salivary fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46900","name":"Destruction anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0191T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93463","name":"Drug admin & hemodynmic meas","description":"Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (list separately in addition to","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4002","name":"Replace strap, any orthosis","description":"Replacement strap, any orthosis, includes all components, any length, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29046","name":"Appl bdy cst sho to hip b th","description":"Application of body cast, shoulder to hips; including both thighs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73590","name":"X-ray exam of lower leg","description":"Radiologic examination; tibia and fibula, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44800","name":"Excision of bowel pouch","description":"Excision of meckels diverticulum (diverticulectomy) or omphalomesenteric duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2715","name":"Prism lens/es","description":"Prism, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26440","name":"Release palm/finger tendon","description":"Tenolysis, flexor tendon; palm or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33891","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73100","name":"X-ray exam of wrist","description":"Radiologic examination, wrist; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0434","name":"Portable liquid 02","description":"Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0051","name":"Cam rel asm ft/legrst rep ea","description":"Cam release assembly, footrest or legrest, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00522","name":"Anes clsd ch px ndl bx pleur","description":"Anesthesia for closed chest procedures; needle biopsy of pleura","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93640","name":"Ep eval 1/2chmbr pacg cvdfb","description":"Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77338","name":"Design mlc device for imrt","description":"Multi-leaf collimator (mlc) device(s) for intensity modulated radiation therapy (imrt), design and construction per imrt plan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0700","name":"Ctlso a-p-l control molded","description":"Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75559","name":"Cardiac mri w/stress img","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84228","name":"Assay of quinine","description":"Quinine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95076","name":"Ingest challenge ini 120 min","description":"Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); initial 120 minutes of testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37615","name":"Ligation major artery neck","description":"Ligation, major artery (eg, post-traumatic, rupture); neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11055","name":"Paring/cutg b9 hyprker les 1","description":"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78472","name":"Gated heart planar single","description":"Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69436","name":"Create eardrum opening","description":"Tympanostomy (requiring insertion of ventilating tube), general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86768","name":"Salmonella antibody","description":"Antibody; salmonella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70488","name":"Ct maxillofacial w/o & w/dye","description":"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4150","name":"Ef complet w/intact nutrient","description":"Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44605","name":"Repair of bowel lesion","description":"Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8485","name":"Pros sock single ply upper l","description":"Prosthetic sock, single ply, fitting, upper limb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78104","name":"Bone marrow imaging body","description":"Bone marrow imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7405","name":"Add ue prost s/d acrylic","description":"Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17281","name":"Dstr mal ls f/e/e/n/l/m .6-1","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4176","name":"Parenteral sol amino acid 7-","description":"Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15842","name":"Nerve palsy microsurg graft","description":"Graft for facial nerve paralysis; free muscle flap by microsurgical technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1752.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99282","name":"Emergency dept visit sf mdm","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99356","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93304","name":"Echo transthoracic","description":"Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25440","name":"Repair nonu scphd carpl b1","description":"Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49442","name":"Place cecostomy tube perc","description":"Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":679.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42820","name":"Remove tonsils and adenoids","description":"Tonsillectomy and adenoidectomy; younger than age 12","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":223.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30802","name":"Ablate inf turbinate submuc","description":"Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":206.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26070","name":"Explore/treat hand joint","description":"Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49435","name":"Insert subq exten to ip cath","description":"Insertion of subcutaneous extension to intraperitoneal cannula or catheter with remote chest exit site (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0293","name":"Hosp bed var ht no sr no mat","description":"Hospital bed, variable height, hi-lo, without side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93457","name":"R hrt art/grft angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injecti","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46614","name":"Anoscopy control bleeding","description":"Anoscopy; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4290","name":"Sacral nerve stim test lead","description":"Sacral nerve stimulation test lead, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95913","name":"Nrv cndj test 13/> studies","description":"Nerve conduction studies; 13 or more studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33405","name":"Replacement aortic valve opn","description":"Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1973.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33988","name":"Insertion of left heart vent","description":"Insertion of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ecmo/ecls","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2251","name":"Brief chkin, 5-10, non-e/m","description":"Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83890","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84375","name":"Chromatogram assay sugars","description":"Sugars, chromatographic, tlc or paper chromatography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2250","name":"Remot img sub by pt, non e/m","description":"Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or p","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35870","name":"Repair vessel graft defect","description":"Repair of graft-enteric fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76516","name":"Echo exam of eye","description":"Ophthalmic biometry by ultrasound echography, a-scan;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23155","name":"Removal of humerus lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":672.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87530","name":"Hsv dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); herpes simplex virus, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7034","name":"Nasal application device","description":"Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88341","name":"Imhchem/imcytchm ea add antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6215","name":"Foam dressing wound filler","description":"Foam dressing, wound filler, sterile, per gram","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77763","name":"Apply intrcav radiat compl","description":"Intracavitary radiation source application; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":587.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3620","name":"Trans shoe solid stirrup exi","description":"Transfer of an orthosis from one shoe to another, solid stirrup, existing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37242","name":"Vasc embolize/occlude artery","description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malfo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44158","name":"Colectomy w/neo-rectum pouch","description":"Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (s or j), includes loop ileostomy, and rectal mucosectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21602","name":"Exc ch wal tum w/o lymphadec","description":"Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1359.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77786","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":380.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63182","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1488.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73120","name":"X-ray exam of hand","description":"Radiologic examination, hand; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27681","name":"Release of lower leg tendons","description":"Tenolysis, flexor or extensor tendon, leg and/or ankle; multiple tendons (through separate incision[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0765","name":"Nerve stimulator for tx n&v","description":"Fda approved nerve stimulator, for treatment of nausea and vomiting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76377","name":"3d render w/intrp postproces","description":"3d rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26593","name":"Release muscles of hand","description":"Release, intrinsic muscles of hand, each muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54340","name":"Rpr hypspad comp simple","description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49495","name":"Rpr ing hernia baby reduc","description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":340.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2036","name":"Kafo plas doub free knee mol","description":"Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4362","name":"Solid skin barrier","description":"Skin barrier; solid, 4 x 4 or equivalent; each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5781","name":"Lower limb pros vacuum pump","description":"Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88361","name":"Tumor immunohistochem/comput","description":"Morphometric analysis, tumor immunohistochemistry (eg, her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; using computer-assisted technology","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0990","name":"Wheelchair elevating leg res","description":"Wheelchair accessory, elevating leg rest, complete assembly, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1640","name":"Pelv band/spread bar thigh c","description":"Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28309","name":"Incision of metatarsals","description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (eg, swanson type cavus foot procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1406","name":"O2/water vapor enrich w/o he","description":"Oxygen and water vapor enriching system without heated delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8609","name":"Artificial cornea","description":"Artificial cornea","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3173.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69140","name":"Remove ear canal lesion(s)","description":"Excision exostosis(es), external auditory canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":707.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38211","name":"Tumor cell deplete of harvst","description":"Transplant preparation of hematopoietic progenitor cells; tumor cell depletion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78730","name":"Urinary bladder retention","description":"Urinary bladder residual study (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64727","name":"Internal neurolysis","description":"Internal neurolysis, requiring use of operating microscope (list separately in addition to code for neuroplasty) (neuroplasty includes external neurolysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86759","name":"Rotavirus antibody","description":"Antibody; rotavirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27846","name":"Treat ankle dislocation","description":"Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":597.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4911","name":"Drain bag/bottle","description":"Drain bag/bottle, for dialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2213","name":"Pneumatic prop tire insert","description":"Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33746","name":"Tis cgen car anomal ea addl","description":"Transcatheter intracardiac shunt (tis) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48400","name":"Injection intraop add-on","description":"Injection procedure for intraoperative pancreatography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27610","name":"Explore/treat ankle joint","description":"Arthrotomy, ankle, including exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64865","name":"Repair of facial nerve","description":"Suture of facial nerve; infratemporal, with or without grafting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77605","name":"Hyperthermia ext gen deep","description":"Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":686.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00921","name":"Anes px male genitalia vasec","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); vasectomy, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01710","name":"Anes px nrv musc upr a&e nos","description":"Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93295","name":"Dev interrog remote 1/2/mlt","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88372","name":"Protein analysis w/probe","description":"Protein analysis of tissue by western blot, with interpretation and report; immunological probe for band identification, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85536","name":"Iron stain peripheral blood","description":"Iron stain, peripheral blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93745","name":"Set-up cardiovert-defibrill","description":"Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ecg, transmission of data to data repository, patient instruction in wearing system and patient re","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96116","name":"Nubhvl xm phys/qhp 1st hr","description":"Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21242","name":"Reconstruction of jaw joint","description":"Arthroplasty, temporomandibular joint, with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28060","name":"Partial removal foot fascia","description":"Fasciectomy, plantar fascia; partial (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":423.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93000","name":"Electrocardiogram complete","description":"Electrocardiogram, routine ecg with at least 12 leads; with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21182","name":"Reconstruct cranial bone","description":"Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting less than 40 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1789.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83873","name":"Assay of csf protein","description":"Myelin basic protein, cerebrospinal fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0105","name":"Colorectal scrn; hi risk ind","description":"Colorectal cancer screening; colonoscopy on individual at high risk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","53",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6198","name":"Alginate dressing > 48 sq in","description":"Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15782","name":"Dermabrasion other than face","description":"Dermabrasion; regional, other than face","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82378","name":"Carcinoembryonic antigen","description":"Carcinoembryonic antigen (cea)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93527","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":378.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78740","name":"Ureteral reflux study","description":"Ureteral reflux study (radiopharmaceutical voiding cystogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26841","name":"Fusion of thumb","description":"Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54163","name":"Repair of circumcision","description":"Repair incomplete circumcision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45116","name":"Partial removal of rectum","description":"Proctectomy, partial, with anastomosis; transsacral approach only (kraske type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1203.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90846","name":"Family psytx w/o pt 50 min","description":"Family psychotherapy (without the patient present), 50 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43830","name":"Gstrst open wo constj tube","description":"Gastrostomy, open; without construction of gastric tube (eg, stamm procedure) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4060","name":"Replace high roll cuff","description":"Replace high roll cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26392","name":"Repair/graft hand tendon","description":"Removal of synthetic rod and insertion of flexor tendon graft, hand or finger (includes obtaining graft), each rod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":821.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3050","name":"Foot arch supp premold metat","description":"Foot, arch support, removable, premolded, metatarsal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30125","name":"Removal of nose lesion","description":"Excision dermoid cyst, nose; complex, under bone or cartilage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69643","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":986.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11401","name":"Exc tr-ext b9+marg 0.6-1 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95962","name":"Electrode stim brain add-on","description":"Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of attendance by a physician or other qualified health care professional (list separately i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69706","name":"Nps surg dilat eust tube bi","description":"Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2551.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27100","name":"Transfer of abdominal muscle","description":"Transfer external oblique muscle to greater trochanter including fascial or tendon extension (graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":699.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42808","name":"Excise pharynx lesion","description":"Excision or destruction of lesion of pharynx, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1060","name":"Wheelchair detachable arms","description":"Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75671","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43840","name":"Gstrrphy sutr duol/gstr ulcr","description":"Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1136.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36584","name":"Compl rplcmt picc rs&i","description":"Replacement, complete, of a peripherally inserted central venous catheter (picc), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87185","name":"Sc std enzyme detcj per nzm","description":"Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36013","name":"Place catheter in artery","description":"Introduction of catheter, right heart or main pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":646.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46753","name":"Reconstruction of anus","description":"Graft (thiersch operation) for rectal incontinence and/or prolapse","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":512.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47550","name":"Bile duct endoscopy add-on","description":"Biliary endoscopy, intraoperative (choledochoscopy) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99355","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2628","name":"Metal frame recipro hip & ca","description":"Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1003.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31395","name":"Reconstruct larynx & pharynx","description":"Pharyngolaryngectomy, with radical neck dissection; with reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2241.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72146","name":"Mri chest spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33974","name":"Remove intra-aortic balloon","description":"Removal of intra-aortic balloon assist device from the ascending aorta, including repair of the ascending aorta, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69700","name":"Close mastoid fistula","description":"Closure postauricular fistula, mastoid (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":543.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8515","name":"Gel cap app device for trach","description":"Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36406","name":"Vnpnxr<3yrs phy/qhp other vn","description":"Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; other vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0942","name":"Cervical head harness/halter","description":"Cervical head harness/halter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1016","name":"Shock absorber for power w/c","description":"Shock absorber for power wheelchair, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11306","name":"Shave skin lesion 0.6-1.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4236","name":"Silvr oxide batt glucose mon","description":"Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","KL","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10008","name":"Fna bx w/fluor gdn ea addl","description":"Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82010","name":"Ketone bodys quan","description":"Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28299","name":"Cor hlx vlgs double osteot","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50840","name":"Replace ureter by bowel","description":"Replacement of all or part of ureter by intestine segment, including intestine anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28576","name":"Treat foot dislocation","description":"Percutaneous skeletal fixation of talotarsal joint dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64617","name":"Chemodener muscle larynx emg","description":"Chemodenervation of muscle(s); larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50970","name":"Ureter endoscopy","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":299.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46715","name":"Rep perf anoper fistu","description":"Repair of low imperforate anus; with anoperineal fistula (cut-back procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73521","name":"X-ray exam hips bi 2 views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42505","name":"Repair salivary duct","description":"Plastic repair of salivary duct, sialodochoplasty; secondary or complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":433.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6704","name":"Term dev, sport/rec/work att","description":"Terminal device, sport/recreational/work attachment, any material, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30430","name":"Revision of nose","description":"Rhinoplasty, secondary; minor revision (small amount of nasal tip work)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":788.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54438","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1082.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78835","name":"Rp quan meas single area","description":"Radiopharmaceutical quantification measurement(s) single area (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35583","name":"Vein byp grft fem-popliteal","description":"In-situ vein bypass; femoral-popliteal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1274.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19120","name":"Removal of breast lesion","description":"Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62302","name":"Myelography lumbar injection","description":"Myelography via lumbar injection, including radiological supervision and interpretation; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77620","name":"Hyperthermia gen intrcv prb","description":"Hyperthermia generated by intracavitary probe(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25259","name":"Manipulate wrist w/anesthes","description":"Manipulation, wrist, under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92651","name":"Aep hearing status deter i&r","description":"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93290","name":"Interrog dev eval icpms ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of 1 or more reco","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95943","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51610","name":"Injection for bladder x-ray","description":"Injection procedure for retrograde urethrocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27496","name":"Decompression of thigh/knee","description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88360","name":"Tumor immunohistochem/manual","description":"Morphometric analysis, tumor immunohistochemistry (eg, her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52647","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1311.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70110","name":"X-ray exam of jaw 4/> views","description":"Radiologic examination, mandible; complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3961","name":"Sewho cap design w/o jnts cf","description":"Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44136","name":"Intestine transplant live","description":"Intestinal allotransplantation; from living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78483","name":"Heart first pass multiple","description":"Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82542","name":"Col chromotography qual/quan","description":"Column chromatography, includes mass spectrometry, if performed (eg, hplc, lc, lc/ms, lc/ms-ms, gc, gc/ms-ms, gc/ms, hplc/ms), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0216T","name":"Njx paravert w/us lumb/sac","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59020","name":"Fetal contract stress test","description":"Fetal contraction stress test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6261","name":"Wound filler gel/paste /oz","description":"Wound filler, gel/paste, per fluid ounce, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28800","name":"Amputation of midfoot","description":"Amputation, foot; midtarsal (eg, chopart type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":435.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93979","name":"Vascular study","description":"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01270","name":"Anes px arteries upr leg nos","description":"Anesthesia for procedures involving arteries of upper leg, including bypass graft; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1087","name":"Wheelchair lightwt fixed arm","description":"High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00732","name":"Anes upr gi ndsc px ercp","description":"Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ercp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69105","name":"Biopsy of external ear canal","description":"Biopsy external auditory canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83500","name":"Assay free hydroxyproline","description":"Hydroxyproline; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2600","name":"Hip clevis/thrust bearing fr","description":"Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46221","name":"Ligation of hemorrhoid(s)","description":"Hemorrhoidectomy, internal, by rubber band ligation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0433","name":"Elisa hiv-1/hiv-2 screen","description":"Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11301","name":"Shave skin lesion 0.6-1.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27025","name":"Fasciotomy hip/thigh any typ","description":"Fasciotomy, hip or thigh, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":777.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68840","name":"Explore/irrigate tear ducts","description":"Probing of lacrimal canaliculi, with or without irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55815","name":"Extensive prostate surgery","description":"Prostatectomy, perineal radical; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01810","name":"Anes px nrv musc f/arm wrst","description":"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82652","name":"Vit d 1 25-dihydroxy","description":"Vitamin d; 1, 25 dihydroxy, includes fraction(s), if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25370","name":"Revise radius or ulna","description":"Multiple osteotomies, with realignment on intramedullary rod (sofield type procedure); radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33536","name":"Cabg arterial four or more","description":"Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01480","name":"Anes open px lower l/a/f nos","description":"Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87250","name":"Virus inoculate eggs/animal","description":"Virus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0151T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86682","name":"Helminth antibody","description":"Antibody; helminth, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97026","name":"Infrared therapy","description":"Application of a modality to 1 or more areas; infrared","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96904","name":"Whole body photography","description":"Whole body integumentary photography, for monitoring of high risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21184","name":"Reconstruct cranial bone","description":"Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 80 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2098.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88184","name":"Flowcytometry/ tc 1 marker","description":"Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6251","name":"Absorpt drg <=16 sq in w/o b","description":"Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4372","name":"Skin barrier solid 4x4 equiv","description":"Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4452","name":"Waterproof tape","description":"Tape, waterproof, per 18 square inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36012","name":"Place catheter in vein","description":"Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":715.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78121","name":"Red cell mass multiple","description":"Red cell volume determination (separate procedure); multiple samplings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93880","name":"Extracranial bilat study","description":"Duplex scan of extracranial arteries; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1820","name":"Ko elas w/ condyle pads & jo","description":"Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33271","name":"Insj subq impltbl dfb elctrd","description":"Insertion of subcutaneous implantable defibrillator electrode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31720","name":"Clearance of airways","description":"Catheter aspiration (separate procedure); nasotracheal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24400","name":"Osteot humerus w/wo int fixj","description":"Osteotomy, humerus, with or without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":693.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32668","name":"Thoracoscopy w/w resect diag","description":"Thoracoscopy, surgical; with diagnostic wedge resection followed by anatomic lung resection (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82136","name":"Amino acids quant 2-5","description":"Amino acids, 2 to 5 amino acids, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01440","name":"Anes px art knee&pop nos","description":"Anesthesia for procedures on arteries of knee and popliteal area; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77767","name":"Hdr rdncl skn surf brachytx","description":"Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":191.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1971","name":"Afo w/ankle joint, prefab","description":"Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":228.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42410","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":488.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28035","name":"Decompression of tibia nerve","description":"Release, tarsal tunnel (posterior tibial nerve decompression)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31584","name":"Laryngoplasty fx rdctj fixj","description":"Laryngoplasty; with open reduction and fixation of (eg, plating) fracture, includes tracheostomy, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22810","name":"Arthrd ant dfrm 4-7 vrt sgm","description":"Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11922","name":"Correct skin color ea 20.0cm","description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75956","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":784.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40700","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":807.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52354","name":"Cystouretero w/biopsy","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74246","name":"X-ray xm upr gi trc 2cntrst","description":"Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01622","name":"Anes dx arthr px shoulder jt","description":"Anesthesia for diagnostic arthroscopic procedures of shoulder joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80192","name":"Assay of procainamide","description":"Procainamide; with metabolites (eg, n-acetyl procainamide)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62145","name":"Repair of skull & brain","description":"Cranioplasty for skull defect with reparative brain surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1297.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76810","name":"Ob us >/= 14 wks addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82626","name":"Dehydroepiandrosterone","description":"Dehydroepiandrosterone (dhea)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37616","name":"Ligation major artery chest","description":"Ligation, major artery (eg, post-traumatic, rupture); chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35305","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0820","name":"Halo cervical into body jack","description":"Halo procedure, cervical halo incorporated into plaster body jacket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76000","name":"Fluoroscopy <1 hr phys/qhp","description":"Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76945","name":"Echo guide villus sampling","description":"Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80434","name":"Insulin tolerance panel","description":"Insulin tolerance panel; for acth insufficiency this panel must include the following: cortisol (82533 x 5) glucose (82947 x 5)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4450","name":"Non-waterproof tape","description":"Tape, non-waterproof, per 18 square inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["AW","GT","GQ","95","AU","AV","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77001","name":"Fluoroguide for vein device","description":"Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic su","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31575","name":"Diagnostic laryngoscopy","description":"Laryngoscopy, flexible; diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88313","name":"Special stains group 2","description":"Special stain including interpretation and report; group ii, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33884","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37211","name":"Thrombolytic art therapy","description":"Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32488","name":"Completion pneumonectomy","description":"Removal of lung, other than pneumonectomy; with all remaining lung following previous removal of a portion of lung (completion pneumonectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1918.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33572","name":"Open coronary endarterectomy","description":"Coronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery performed in conjunction with coronary artery bypass graft procedure, each vessel (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21208","name":"Augmentation of facial bones","description":"Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33992","name":"Rmvl perq left heart vad","description":"Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), at separate and distinct session from insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21049","name":"Excis uppr jaw cyst w/repair","description":"Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":985.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59100","name":"Remove uterus lesion","description":"Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":754.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6228","name":"Gauze <= 16 sq in water/sal","description":"Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73540","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93350","name":"Stress tte only","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21462","name":"Optx mndblr fx w/ntrdntl","description":"Open treatment of mandibular fracture; with interdental fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86331","name":"Immunodiffusion ouchterlony","description":"Immunodiffusion; gel diffusion, qualitative (ouchterlony), each antigen or antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20827","name":"Replantation thumb complete","description":"Replantation, thumb (includes distal tip to mp joint), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28208","name":"Repair of foot tendon","description":"Repair, tendon, extensor, foot; primary or secondary, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82465","name":"Assay bld/serum cholesterol","description":"Cholesterol, serum or whole blood, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11601","name":"Exc tr-ext mal+marg 0.6-1 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97605","name":"Neg prs wnd ther dme<=50sqcm","description":"Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (dme), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47122","name":"Extensive removal of liver","description":"Hepatectomy, resection of liver; trisegmentectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85384","name":"Fibrinogen activity","description":"Fibrinogen; activity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75743","name":"Artery x-rays lungs","description":"Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32653","name":"Thoracoscopy remov fb/fibrin","description":"Thoracoscopy, surgical; with removal of intrapleural foreign body or fibrin deposit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":847.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4611","name":"Heavy duty battery","description":"Battery, heavy duty; replacement for patient owned ventilator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7005","name":"Nondisposable nebulizer set","description":"Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81233","name":"Btk gene common variants","description":"Btk (brutons tyrosine kinase) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, c481s, c481r, c481f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6384","name":"Postop dsg cast chg shlder/t","description":"Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1261.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78320","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31298","name":"Nsl/sins ndsc surg frnt&sphn","description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2683.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21139","name":"Rdctj forehead cntrg&setback","description":"Reduction forehead; contouring and setback of anterior frontal sinus wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":928.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37660","name":"Ligation common iliac vein","description":"Ligation of common iliac vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1156.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29915","name":"Hip arthro acetabuloplasty","description":"Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29905","name":"Subtalar arthro w/exc","description":"Arthroscopy, subtalar joint, surgical; with synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2186","name":"Adj motion knee jnt lerman t","description":"Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21215","name":"Lower jaw bone graft","description":"Graft, bone; mandible (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34716","name":"Opn ax/subcla art expos cndt","description":"Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21208","name":"Augmentation of facial bones","description":"Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1370.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71020","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96101","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61315","name":"Crnec/crnot ittl ntracereblr","description":"Craniectomy or craniotomy for evacuation of hematoma, infratentorial; intracerebellar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87109","name":"Mycoplasma","description":"Culture, mycoplasma, any source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78266","name":"Gstr empt img sm bwl&colon","description":"Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66940","name":"Extraction of lens","description":"Removal of lens material; extracapsular (other than 66840, 66850, 66852)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77334","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81186","name":"Cacna1a gen known famil vrnt","description":"Cacna1a (calcium voltage-gated channel subunit alpha1 a) (eg, spinocerebellar ataxia) gene analysis; known familial variant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92025","name":"Cptrized corneal topography","description":"Computerized corneal topography, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35703","name":"Expl n/flwd surg lxtr art","description":"Exploration not followed by surgical repair, artery; lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial, peroneal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37181","name":"Splice spleen/kidney veins","description":"Venous anastomosis, open; splenorenal, distal (selective decompression of esophagogastric varices, any technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2045.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21344","name":"Open tx compl front sinus fx","description":"Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1127.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21031","name":"Remove exostosis mandible","description":"Excision of torus mandibularis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":312.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36589","name":"Removal tunneled cv cath","description":"Removal of tunneled central venous catheter, without subcutaneous port or pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33362","name":"Replace aortic valve open","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open femoral artery approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0102","name":"Prostate ca screening; dre","description":"Prostate cancer screening; digital rectal examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01390","name":"Anes cls px upr tib fib&/pat","description":"Anesthesia for all closed procedures on upper ends of tibia, fibula, and/or patella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22527","name":"Idet 1 or more levels","description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1508.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8500","name":"Artificial larynx","description":"Artificial larynx, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90937","name":"Hemodialysis repeated eval","description":"Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92081","name":"Limited visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, autoplot, arc perimeter, or single stimulus level automated test, such as octopus 3 or 7 equivalent)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2375","name":"Non-expandable controller","description":"Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26373","name":"Repair finger/hand tendon","description":"Repair or advancement of profundus tendon, with intact superficialis tendon; secondary without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":717.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26568","name":"Lengthen metacarpal/finger","description":"Osteoplasty, lengthening, metacarpal or phalanx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84432","name":"Assay of thyroglobulin","description":"Thyroglobulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25805","name":"Arthrd wrist w/sliding graft","description":"Arthrodesis, wrist; with sliding graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":715.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57545","name":"Remove cervix/repair pelvis","description":"Excision of cervical stump, abdominal approach; with pelvic floor repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":532.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96110","name":"Developmental screen w/score","description":"Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2612","name":"Gen use back cush wdth>=22in","description":"General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76979","name":"Us trgt dyn mbubb ea addl","description":"Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate injection (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50234","name":"Removal of kidney & ureter","description":"Nephrectomy with total ureterectomy and bladder cuff; through same incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1058.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8035","name":"Custom breast prosthesis","description":"Custom breast prosthesis, post mastectomy, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1784.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82664","name":"Electrophoretic test","description":"Electrophoretic technique, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94668","name":"Mnpj chest wall sbsq","description":"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92286","name":"Ant sgm img i&r speclr mic","description":"Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44391","name":"Colonoscopy for bleeding","description":"Colonoscopy through stoma; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0519T","name":"Rmv&rplcmt pg wcs lv both","description":"Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; both components (battery and transmitter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84081","name":"Assay phosphatidylglycerol","description":"Phosphatidylglycerol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57300","name":"Repair rectum-vagina fistula","description":"Closure of rectovaginal fistula; vaginal or transanal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35306","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":394.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88274","name":"Cytogenetics 25-99","description":"Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45382","name":"Colonoscopy w/control bleed","description":"Colonoscopy, flexible; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7525","name":"Tracheostomy mask","description":"Tracheostomy mask, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72196","name":"Mri pelvis w/dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70470","name":"Ct head/brain w/o & w/dye","description":"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64832","name":"Repair nerve add-on","description":"Suture of digital nerve, hand or foot; each additional digital nerve (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":283.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69505","name":"Remove mastoid structures","description":"Mastoidectomy; modified radical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":973.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97034","name":"App mdlty 1+cntrst bth ea 15","description":"Application of a modality to 1 or more areas; contrast baths, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0288","name":"Recon, cta for surg plan","description":"Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83070","name":"Assay of hemosiderin qual","description":"Hemosiderin, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43287","name":"Esphg dstl 2/3 w/laps moblj","description":"Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle and upper mediastinal esophagus and thoracic e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3003.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86835","name":"Hla class ii semiquant panel","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); semi-quantitative panel (eg, titer), hla class ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36228","name":"Place cath intracranial art","description":"Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (lis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43340","name":"Fuse esophagus & intestine","description":"Esophagojejunostomy (without total gastrectomy); abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1156.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6450","name":"Elb disart prosth tiss shap","description":"Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23040","name":"Arthrt gh jt expl/drg/rmv fb","description":"Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92065","name":"Orthop traing pfrmd phys/qhp","description":"Orthoptic training; performed by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85597","name":"Phospholipid pltlt neutraliz","description":"Phospholipid neutralization; platelet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62190","name":"Establish brain cavity shunt","description":"Creation of shunt; subarachnoid/subdural-atrial, -jugular, -auricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":838.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33223","name":"Relocate pocket for defib","description":"Relocation of skin pocket for implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":352.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21230","name":"Rib cartilage graft","description":"Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38206","name":"Harvest auto stem cells","description":"Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11980","name":"Implant hormone pellet(s)","description":"Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99212","name":"Office o/p est sf 10 min","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 10 minutes must be met o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33535","name":"Cabg arterial three","description":"Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73115","name":"Contrast x-ray of wrist","description":"Radiologic examination, wrist, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35654","name":"Bpg axillary-femoral-femoral","description":"Bypass graft, with other than vein; axillary-femoral-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82943","name":"Assay of glucagon","description":"Glucagon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5008","name":"Hearing screening","description":"Hearing screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0207T","name":"Clear eyelid gland w/heat","description":"Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83721","name":"Assay of blood lipoprotein","description":"Lipoprotein, direct measurement; ldl cholesterol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42509","name":"Parotid duct diversion","description":"Parotid duct diversion, bilateral (wilke type procedure); with excision of both submandibular glands","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82805","name":"Blood gases w/o2 saturation","description":"Gases, blood, any combination of ph, pco2, po2, co2, hco3 (including calculated o2 saturation); with o2 saturation, by direct measurement, except pulse oximetry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82634","name":"Deoxycortisol","description":"Deoxycortisol, 11-","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95806","name":"Sleep study unatt&resp efft","description":"Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87253","name":"Virus inoculate tissue addl","description":"Virus isolation; tissue culture, additional studies or definitive identification (eg, hemabsorption, neutralization, immunofluorescence stain), each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82375","name":"Assay carboxyhb quant","description":"Carboxyhemoglobin; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31570","name":"Laryngoscope w/vc inj","description":"Laryngoscopy, direct, with injection into vocal cord(s), therapeutic;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78605","name":"Brain image 4+ views","description":"Brain imaging, minimum 4 static views;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72197","name":"Mri pelvis w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15240","name":"Fth/gft f/c/c/m/n/ax/g/h/f20","description":"Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19300","name":"Mastectomy for gynecomastia","description":"Mastectomy for gynecomastia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42408","name":"Excision of salivary cyst","description":"Excision of sublingual salivary cyst (ranula)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63600","name":"Remove spinal cord lesion","description":"Creation of lesion of spinal cord by stereotactic method, percutaneous, any modality (including stimulation and/or recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":994.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0078","name":"Care manag h vst new pt 45 m","description":"Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32562","name":"Lyse chest fibrin subq day","description":"Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); subsequent day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0638","name":"Lso sag-coronal panel custom","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2710","name":"Glass/plastic slab off prism","description":"Slab off prism, glass or plastic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77049","name":"Mri breast c-+ w/cad bi","description":"Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (cad real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0290","name":"Hosp bed fx ht w/o rails w/m","description":"Hospital bed, fixed height, without side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67028","name":"Injection eye drug","description":"Intravitreal injection of a pharmacologic agent (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92582","name":"Conditioning play audiometry","description":"Conditioning play audiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9538","name":"Tc99m pyrophosphate","description":"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46948","name":"Int hrhc tranal dartlzj 2+","description":"Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64865","name":"Repair of facial nerve","description":"Suture of facial nerve; infratemporal, with or without grafting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":889.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98981","name":"Rtm tx mgmt ea addl 20 min","description":"Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; each additional 20 minutes (list separately in","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91065","name":"Breath hydrogen/methane test","description":"Breath hydrogen or methane test (eg, for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal gastrointestinal transit)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96133","name":"Nrpsyc tst eval phys/qhp ea","description":"Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the pati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69501","name":"Mastoidectomy","description":"Transmastoid antrotomy (simple mastoidectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19304","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":372.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0518T","name":"Rmvl pg wcs lv battery only","description":"Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; battery component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92135","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76857","name":"Us exam pelvic limited","description":"Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24670","name":"Cltx ulnar fx prox w/o mnpj","description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":242.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0308T","name":"Insj ocular telescope prosth","description":"Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular lens prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":810.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8507","name":"Trach-esoph voice pros pt in","description":"Tracheo-esophageal voice prosthesis, patient inserted, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84704","name":"Hcg free betachain test","description":"Gonadotropin, chorionic (hcg); free beta chain","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45020","name":"Drainage of rectal abscess","description":"Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94617","name":"Exercise tst brncspsm w/ecg","description":"Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic recording(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26080","name":"Explore/treat finger joint","description":"Arthrotomy, with exploration, drainage, or removal of loose or foreign body; interphalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01716","name":"Anes nrv msc upr a&e tndsis","description":"Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenodesis, rupture of long tendon of biceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93640","name":"Ep eval 1/2chmbr pacg cvdfb","description":"Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91303","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11443","name":"Exc face-mm b9+marg 2.1-3 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4433","name":"Urine ost pch bar w lock fln","description":"Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1025","name":"Kyphosis pad floating","description":"Addition to ctlso or scoliosis orthosis, kyphosis pad, floating","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48400","name":"Injection intraop add-on","description":"Injection procedure for intraoperative pancreatography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27824","name":"Treat lower leg fracture","description":"Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82010","name":"Ketone bodys quan","description":"Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61312","name":"Crnec/crnot sttl xdrl/sdrl","description":"Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29804","name":"Jaw arthroscopy/surgery","description":"Arthroscopy, temporomandibular joint, surgical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44680","name":"Surgical revision intestine","description":"Intestinal plication (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":878.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0517","name":"Remove drug implant","description":"Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0982","name":"Back upholstery, replacement","description":"Wheelchair accessory, back upholstery, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26991","name":"Drainage of pelvis bursa","description":"Incision and drainage, pelvis or hip joint area; infected bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50548","name":"Laparo remove w/ureter","description":"Laparoscopy, surgical; nephrectomy with total ureterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80194","name":"Assay of quinidine","description":"Quinidine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92607","name":"Ex for speech device rx 1hr","description":"Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4314","name":"Cath w/drainage 2-way latex","description":"Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11001","name":"Dbrdmt ecz/infct skn ea addl","description":"Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6691","name":"Removable insert each","description":"Upper extremity addition, removable insert, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27618","name":"Exc leg/ankle tum < 3 cm","description":"Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2405","name":"Knee joint drop lock ea jnt","description":"Addition to knee joint, drop lock, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95851","name":"Range of motion measurements","description":"Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47300","name":"Surgery for liver lesion","description":"Marsupialization of cyst or abscess of liver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":940.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1700","name":"Jaw motion rehab system","description":"Jaw motion rehabilitation system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8400","name":"Sheath below knee","description":"Prosthetic sheath, below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77370","name":"Radiation physics consult","description":"Special medical radiation physics consultation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53420","name":"Reconstruct urethra stage 1","description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2060","name":"Hkafo torsion ball bearing j","description":"Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15220","name":"Fth/gft fr s/a/l 20 sq cm/<","description":"Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0503","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33310","name":"Exploratory heart surgery","description":"Cardiotomy, exploratory (includes removal of foreign body, atrial or ventricular thrombus); without bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0245T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":490.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33530","name":"Coronary artery bypass/reop","description":"Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":459.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93770","name":"Determination venous press","description":"Determination of venous pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92341","name":"Fit spectacles bifocal","description":"Fitting of spectacles, except for aphakia; bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7008","name":"Disposable nebulizer prefill","description":"Large volume nebulizer, disposable, prefilled, used with aerosol compressor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25447","name":"Arthrp ntrcrp/crp/mtcr ntrps","description":"Arthroplasty, intercarpal or carpometacarpal joints; interposition (eg, tendon)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69666","name":"Repair middle ear structures","description":"Repair oval window fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57540","name":"Removal of residual cervix","description":"Excision of cervical stump, abdominal approach;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27096","name":"Inject sacroiliac joint","description":"Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or ct) including arthrography when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0206","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2121","name":"Lenticular lens, single","description":"Lenticular lens, per lens, single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87209","name":"Smear complex stain","description":"Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80048","name":"Basic metabolic pnl total ca","description":"Basic metabolic panel (calcium, total) this panel must include the following: calcium, total (82310) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) potassium (84132) sodium (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70481","name":"Ct orbit/ear/fossa w/dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27000","name":"Tenotomy adductor hip perq","description":"Tenotomy, adductor of hip, percutaneous (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":327.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78451","name":"Ht muscle image spect sing","description":"Myocardial perfusion imaging, tomographic (spect) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90958","name":"Esrd srv 2-3 vsts p mo 12-19","description":"End-stage renal disease (esrd) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":309.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52283","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with steroid injection into stricture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38221","name":"Dx bone marrow biopsies","description":"Diagnostic bone marrow; biopsy(ies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95722","name":"Eeg phy/qhp>36<60 hr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 36 hours, up to 60 hours of eeg recording, with video (veeg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38242","name":"Transplt allo lymphocytes","description":"Allogeneic lymphocyte infusions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2525","name":"Th/wght bear nar m-l brim mo","description":"Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":653.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26499","name":"Correction claw finger other","description":"Correction claw finger, other methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":706.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41512","name":"Tongue suspension","description":"Tongue base suspension, permanent suture technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2220","name":"Solid propuls tire, repl, ea","description":"Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42955","name":"Surgical opening of throat","description":"Pharyngostomy (fistulization of pharynx, external for feeding)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":588.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20936","name":"Sp bone agrft local add-on","description":"Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63102","name":"Remove vert body dcmprn lmbr","description":"Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); lumbar, single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86431","name":"Rheumatoid factor quant","description":"Rheumatoid factor; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24420","name":"Osteoplasty humerus","description":"Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22900","name":"Exc abdl tum deep < 5 cm","description":"Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57423","name":"Repair paravag defect lap","description":"Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":591.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58321","name":"Artificial insemination","description":"Artificial insemination; intra-cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84080","name":"Assay alkaline phosphatases","description":"Phosphatase, alkaline; isoenzymes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0494","name":"Emr hd pmp elec/combo, rep","description":"Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13160","name":"Sec clsr surg wnd/dehsn xtn","description":"Secondary closure of surgical wound or dehiscence, extensive or complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2335","name":"Anterior swing band","description":"Addition to lower extremity, anterior swing band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68200","name":"Treat eyelid by injection","description":"Subconjunctival injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86160","name":"Complement antigen","description":"Complement; antigen, each component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9985","name":"Remote e/m est. pt 25mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history;  a detailed exam","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45340","name":"Sig w/tndsc balloon dilation","description":"Sigmoidoscopy, flexible; with transendoscopic balloon dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86615","name":"Bordetella antibody","description":"Antibody; bordetella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44603","name":"Suture small intestine","description":"Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; multiple perforations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2330","name":"Head control proximity switc","description":"Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93923","name":"Upr/lxtr art stdy 3+ lvls","description":"Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional doppler wave","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0621","name":"Sio flex pelvic/sacr pre ots","description":"Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92358","name":"Aphakia prosth service temp","description":"Prosthesis service for aphakia, temporary (disposable or loan, including materials)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2307","name":"Lens sphcy trifocal 4.25-7/.","description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, .12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20973","name":"Bone/skin graft great toe","description":"Free osteocutaneous flap with microvascular anastomosis; great toe with web space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2557.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0935","name":"Cont pas motion exercise dev","description":"Continuous passive motion exercise device for use on knee only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21454","name":"Optx mndblr fx xtrnl fixj","description":"Open treatment of mandibular fracture with external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92543","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33366","name":"Trcath replace aortic valve","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; transapical exposure (eg, left thoracotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1373.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59072","name":"Umbilical cord occlud w/us","description":"Fetal umbilical cord occlusion, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":467.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21142","name":"Rcnstj midface lefort i 2pcs","description":"Reconstruction midface, lefort i; 2 pieces, segment movement in any direction, without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1098.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78262","name":"Gastroesophageal reflux std","description":"Gastroesophageal reflux study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54450","name":"Preputial stretching","description":"Foreskin manipulation including lysis of preputial adhesions and stretching","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3906","name":"Who w/o joints cf","description":"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26235","name":"Partial removal finger bone","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82607","name":"Vitamin b-12","description":"Cyanocobalamin (vitamin b-12);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63710","name":"Graft repair of spine defect","description":"Dural graft, spinal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6457","name":"Tubular dressing","description":"Tubular dressing with or without elastic, any width, per linear yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92020","name":"Gonioscopy","description":"Gonioscopy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23405","name":"Incision of tendon & muscle","description":"Tenotomy, shoulder area; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":519.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88342","name":"Imhchem/imcytchm 1st antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28055","name":"Neurectomy foot","description":"Neurectomy, intrinsic musculature of foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":309.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43285","name":"Rmvl esophgl sphnctr dev","description":"Removal of esophageal sphincter augmentation device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53270","name":"Removal of urethra gland","description":"Excision or fulguration; skenes glands","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75736","name":"Artery x-rays pelvis","description":"Angiography, pelvic, selective or supraselective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1840","name":"Ko derot ant cruciate custom","description":"Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15820","name":"Blepharoplasty lower eyelid","description":"Blepharoplasty, lower eyelid;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27487","name":"Revise/replace knee joint","description":"Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1492.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78433","name":"Myocrd img pet 2rtracer ct","description":"Myocardial imaging, positron emission tomography (pet), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91112","name":"Gi wireless capsule measure","description":"Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1072.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78606","name":"Brain image w/flow 4 + views","description":"Brain imaging, minimum 4 static views; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2214","name":"Lens sphcyl bifocal over 12.","description":"Spherocylinder, bifocal, sphere over plus or minus 12.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5972","name":"Flexible keel foot","description":"All lower extremity prostheses, foot, flexible keel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2605","name":"Position wc cush wdth <22 in","description":"Positioning wheelchair seat cushion, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2305","name":"Lens sphcy trifocal 4.0/4.25","description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00 cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43273","name":"Endoscopic pancreatoscopy","description":"Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (list separately in addition to code(s) for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95928","name":"C motor evoked uppr limbs","description":"Central motor evoked potential study (transcranial motor stimulation); upper limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99224","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0995","name":"Wc calf rest, pad replacemnt","description":"Wheelchair accessory, calf rest/pad, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99183","name":"Hyperbaric oxygen therapy","description":"Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11760","name":"Repair of nail bed","description":"Repair of nail bed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44404","name":"Colonoscopy w/injection","description":"Colonoscopy through stoma; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":307.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77301","name":"Radiotherapy dose plan imrt","description":"Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1522.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33697","name":"Compl rpr tof w/pulm atresia","description":"Complete repair tetralogy of fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49441","name":"Place duod/jej tube perc","description":"Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27185","name":"Revision of femur epiphysis","description":"Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52318","name":"Remove bladder stone","description":"Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24110","name":"Exc/curtg b1 cst/b9 tum hum","description":"Excision or curettage of bone cyst or benign tumor, humerus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78010","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81239","name":"Dmpk gene charac alleles","description":"Dmpk (dm1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; characterization of alleles (eg, expanded size)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1801","name":"Sps/pass elbow device","description":"Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55650","name":"Remove sperm duct pouch","description":"Vesiculectomy, any approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82951","name":"Glucose tolerance test (gtt)","description":"Glucose; tolerance test (gtt), 3 specimens (includes glucose)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0150T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76827","name":"Echo exam of fetal heart","description":"Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0620","name":"Cap bld skin piercing laser","description":"Skin piercing device for collection of capillary blood, laser, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95885","name":"Musc tst done w/nerv tst lim","description":"Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33417","name":"Repair of aortic valve","description":"Aortoplasty (gusset) for supravalvular stenosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80188","name":"Assay of primidone","description":"Primidone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65135","name":"Insert ocular implant","description":"Insertion of ocular implant secondary; after enucleation, muscles not attached to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77318","name":"Brachytx isodose complex","description":"Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29900","name":"Mcp joint arthroscopy dx","description":"Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98928","name":"Osteopath manj 7-8 regions","description":"Osteopathic manipulative treatment (omt); 7-8 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63101","name":"Remove vert body dcmprn thrc","description":"Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic, single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2091.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68330","name":"Revise eyelid lining","description":"Repair of symblepharon; conjunctivoplasty, without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87476","name":"Lyme dis dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); borrelia burgdorferi, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93572","name":"Iv dop vel&/press c flo ea","description":"Intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, when performed; each additional vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29862","name":"Hip arthr0 w/debridement","description":"Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":683.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34844","name":"Endovasc visc aorta 4 graft","description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61530","name":"Removal of brain lesion","description":"Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; combined with middle/posterior fossa craniotomy/craniectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84550","name":"Assay of blood/uric acid","description":"Uric acid; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88140","name":"Sex chromatin identification","description":"Sex chromatin identification; peripheral blood smear, polymorphonuclear drumsticks","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01968","name":"Anes/analg cs dlvr neuraxial","description":"Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6686","name":"Suction socket","description":"Upper extremity addition, suction socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6370","name":"Thoracic passive restor cap","description":"Interscapular thoracic, passive restoration (shoulder cap only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1343.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76802","name":"Ob us < 14 wks addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54415","name":"Remove self-contd penis pros","description":"Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87184","name":"Sc std disk method per plate","description":"Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61105","name":"Tdh sdrl/ventr pnxr","description":"Twist drill hole for subdural or ventricular puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27328","name":"Exc thigh/knee tum deep <5cm","description":"Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35001","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, carotid, subclavian artery, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":986.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93610","name":"Intra-atrial pacing","description":"Intra-atrial pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57558","name":"D&c of cervical stump","description":"Dilation and curettage of cervical stump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25680","name":"Cltx trns-scphprlnr fx mnpj","description":"Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":440.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31257","name":"Nsl/sins ndsc tot w/sphendt","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0910","name":"Trapeze bar attached to bed","description":"Trapeze bars, a/k/a patient helper, attached to bed, with grab bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64463","name":"Pvb thoracic cont infusion","description":"Paravertebral block (pvb) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46600","name":"Diagnostic anoscopy spx","description":"Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97167","name":"Ot eval high complex 60 min","description":"Occupational therapy evaluation, high complexity, requiring these components: an occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88363","name":"Xm archive tissue molec anal","description":"Examination and selection of retrieved archival (ie, previously diagnosed) tissue(s) for molecular analysis (eg, kras mutational analysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87391","name":"Hiv-2 ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hiv-2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24560","name":"Cltx hum epcndylr fx wo mnpj","description":"Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4321","name":"Cath therapeutic irrig agent","description":"Therapeutic agent for urinary catheter irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23190","name":"Ostectomy scapula partial","description":"Ostectomy of scapula, partial (eg, superior medial angle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53510","name":"Repair of urethra injury","description":"Urethrorrhaphy, suture of urethral wound or injury; perineal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23071","name":"Exc shoulder les sc 3 cm/>","description":"Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83897","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0114","name":"Crutch underarm pair no wood","description":"Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19298","name":"Place breast rad tube/caths","description":"Placement of radiotherapy after loading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20802","name":"Replantation arm complete","description":"Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2335.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61557","name":"Incise skull/sutures","description":"Craniotomy for craniosynostosis; bifrontal bone flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1534.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6531","name":"Compress stking bk30-40 surg","description":"Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["AW","GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33676","name":"Close mult vsd w/resection","description":"Closure of multiple ventricular septal defects; with pulmonary valvotomy or infundibular resection (acyanotic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1760.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78709","name":"K flow/funct image multiple","description":"Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":296.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64555","name":"Implant neuroelectrodes","description":"Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1515.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6703","name":"Term dev, passive hand mitt","description":"Terminal device, passive hand/mitt, any material, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":215.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0288","name":"Recon, cta for surg plan","description":"Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36510","name":"Insertion of catheter vein","description":"Catheterization of umbilical vein for diagnosis or therapy, newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81166","name":"Brca1 gene full dup/del alys","description":"Brca1 (brca1, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0392","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1348.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0984","name":"Add pwr tiller","description":"Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97033","name":"App mdlty 1+iontphrsis ea 15","description":"Application of a modality to 1 or more areas; iontophoresis, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27146","name":"Incision of hip bone","description":"Osteotomy, iliac, acetabular or innominate bone;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1083.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69505","name":"Remove mastoid structures","description":"Mastoidectomy; modified radical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76776","name":"Us exam k transpl w/doppler","description":"Ultrasound, transplanted kidney, real time and duplex doppler with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46715","name":"Rep perf anoper fistu","description":"Repair of low imperforate anus; with anoperineal fistula (cut-back procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2628","name":"Metal frame recipro hip & ca","description":"Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83722","name":"Lipoprtn dir meas sd ldl chl","description":"Lipoprotein, direct measurement; small dense ldl cholesterol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27396","name":"Transplant of thigh tendon","description":"Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64788","name":"Remove skin nerve lesion","description":"Excision of neurofibroma or neurolemmoma; cutaneous nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88112","name":"Cytopath cell enhance tech","description":"Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7527","name":"Trach/laryn tube plug/stop","description":"Tracheostomy/laryngectomy tube plug/stop, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2425","name":"Knee disc/dial lock/adj flex","description":"Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00908","name":"Anes perineal prostatectomy","description":"Anesthesia for; perineal prostatectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35638","name":"Bpg aortobi-iliac","description":"Bypass graft, with other than vein; aortobi-iliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1535.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01202","name":"Anes arthroscopic px hip jt","description":"Anesthesia for arthroscopic procedures of hip joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69603","name":"Revj mstdc rsltg rad mstdc","description":"Revision mastoidectomy; resulting in radical mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1018.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88141","name":"Cytopath c/v interpret","description":"Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0196","name":"Gel pressure mattress","description":"Gel pressure mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8603","name":"Collagen imp urinary 2.5 ml","description":"Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25078","name":"Resect forarm/wrist tum 3cm>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":992.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60650","name":"Laparoscopy adrenalectomy","description":"Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21242","name":"Reconstruction of jaw joint","description":"Arthroplasty, temporomandibular joint, with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":811.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43400","name":"Ligate esophagus veins","description":"Ligation, direct, esophageal varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6014","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0297","name":"Hosp bed total elect w/o mat","description":"Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78120","name":"Red cell mass single","description":"Red cell volume determination (separate procedure); single sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6692","name":"Silicon gel insert w/wo lock","description":"Upper extremity addition, silicone gel insert or equal, with or without locking mechanism, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21188","name":"Reconstruction of midface","description":"Reconstruction midface, osteotomies (other than lefort type) and bone grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87538","name":"Hiv-2 probe&revrse trnscripj","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-2, amplified probe technique, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0144A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0730","name":"Tens four lead","description":"Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74175","name":"Cta abdomen w/contrast","description":"Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93621","name":"Comp ep evl l pac&rec c sins","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67250","name":"Reinforce eye wall","description":"Scleral reinforcement (separate procedure); without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24586","name":"Optx partclr fx&/dislc elbow","description":"Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56441","name":"Lysis of labial adhesions","description":"Lysis of labial adhesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95018","name":"All tstg perq&iq drugs/biol","description":"Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4313","name":"Catheter w/bag 3-way","description":"Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0980","name":"Peroneal straps pair pre ots","description":"Peroneal straps, prefabricated, off-the-shelf, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86384","name":"Nitroblue tetrazolium dye","description":"Nitroblue tetrazolium dye test (ntd)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1016","name":"Shock absorber for power w/c","description":"Shock absorber for power wheelchair, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1171","name":"Wheelchair amputee w/o leg r","description":"Amputee wheelchair, fixed full length arms, without footrests or legrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90962","name":"Esrd serv 1 visit p mo 20+","description":"End-stage renal disease (esrd) related services monthly, for patients 20 years of age and older; with 1 face-to-face visit by a physician or other qualified health care professional per month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33767","name":"Shunt supr v/c p-art bth lng","description":"Shunt; superior vena cava to pulmonary artery for flow to both lungs (bidirectional glenn procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33016","name":"Pericardiocentesis w/imaging","description":"Pericardiocentesis, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91010","name":"Esophagus motility study","description":"Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72130","name":"Ct chest spine w/o & w/dye","description":"Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43232","name":"Esophagoscopy w/us needle bx","description":"Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94012","name":"Spirmtry w/brnchdil inf-2 yr","description":"Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3400","name":"Shoe metatarsal bar wedge ro","description":"Metatarsal bar wedge, rocker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42892","name":"Revision of pharyngeal walls","description":"Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior pharyngeal walls","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62370","name":"Anl sp inf pmp w/mdreprg&fil","description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill of a physician or other qualified health care professional)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63076","name":"Neck spine disk surgery","description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83001","name":"Assay of gonadotropin (fsh)","description":"Gonadotropin; follicle stimulating hormone (fsh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01502","name":"Anes px art lower leg emblc","description":"Anesthesia for procedures on arteries of lower leg, including bypass graft; embolectomy, direct or with catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67935","name":"Repair eyelid wound","description":"Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; full thickness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27156","name":"Revision of hip bones","description":"Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy and with open reduction of hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1452.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64872","name":"Subsequent repair of nerve","description":"Suture of nerve; requiring secondary or delayed suture (list separately in addition to code for primary neurorrhaphy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6454","name":"Self-adher band w>=3in <5in/yd","description":"Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25265","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25624","name":"Cltx carpl scphd fx w/mnpj","description":"Closed treatment of carpal scaphoid (navicular) fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":402.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80164","name":"Assay dipropylacetic acd tot","description":"Valproic acid (dipropylacetic acid); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93615","name":"Esophageal recording","description":"Esophageal recording of atrial electrogram with or without ventricular electrogram(s);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31201","name":"Removal of ethmoid sinus","description":"Ethmoidectomy; intranasal, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35005","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, vertebral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":877.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1802","name":"Adjst forearm pro/sup device","description":"Dynamic adjustable forearm pronation/supination device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63088","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":227.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87271","name":"Cytomegalovirus dfa","description":"Infectious agent antigen detection by immunofluorescent technique; cytomegalovirus, direct fluorescent antibody (dfa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0071","name":"Fr cstr comp pne tire rep ea","description":"Front caster assembly, complete, with pneumatic tire, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74485","name":"Dilation urtr/urt rs&i","description":"Dilation of ureter(s) or urethra, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15040","name":"Harvest cultured skin graft","description":"Harvest of skin for tissue cultured skin autograft, 100 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86817","name":"Hla typing dr/dq","description":"Hla typing; dr/dq, multiple antigens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33412","name":"Replacement of aortic valve","description":"Replacement, aortic valve; with transventricular aortic annulus enlargement (konno procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67346","name":"Biopsy eye muscle","description":"Biopsy of extraocular muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99367","name":"Team conf w/o pat by phys","description":"Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32215","name":"Treat chest lining","description":"Pleural scarification for repeat pneumothorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":633.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31510","name":"Laryngoscopy with biopsy","description":"Laryngoscopy, indirect; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78300","name":"Bone imaging limited area","description":"Bone and/or joint imaging; limited area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4463","name":"Surgical dress holder reuse","description":"Surgical dressing holder, reusable, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63663","name":"Revise spine eltrd perq aray","description":"Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4248","name":"Chlorhexidine antisept","description":"Chlorhexidine containing antiseptic, 1 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93355","name":"Echo transesophageal (tee)","description":"Echocardiography, transesophageal (tee) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg, tavr, transcatheter pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":218.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22842","name":"Insert spine fixation device","description":"Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12035","name":"Intmd rpr s/a/t/ext 12.6-20","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6915","name":"Hand restoration replacmnt g","description":"Hand restoration (shading, and measurements included), replacement glove for above","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":311.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0630","name":"Lso r post pnl sj-t9 pre cst","description":"Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8421","name":"Ready gradient sleev/glov","description":"Gradient pressure aid (sleeve and glove combination), ready made","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52346","name":"Cystouretero w/renal strict","description":"Cystourethroscopy with ureteroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":359.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C2617","name":"Stent, non-cor, tem w/o del","description":"Stent, non-coronary, temporary, without delivery system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24930","name":"Amputation follow-up surgery","description":"Amputation, arm through humerus; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":654.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63702","name":"Repair of spinal herniation","description":"Repair of meningocele; larger than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1297.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36589","name":"Removal tunneled cv cath","description":"Removal of tunneled central venous catheter, without subcutaneous port or pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2520","name":"Contact lens hydrophilic","description":"Contact lens, hydrophilic, spherical, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36217","name":"Place catheter in artery","description":"Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1545.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33985","name":"Ecmo/ecls rmvl ctr cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":447.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86707","name":"Hepatitis be antibody","description":"Hepatitis be antibody (hbeab)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28615","name":"Repair foot dislocation","description":"Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":673.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43200","name":"Esophagoscopy flexible brush","description":"Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39401","name":"Mediastinoscpy w/medstnl bx","description":"Mediastinoscopy; includes biopsy(ies) of mediastinal mass (eg, lymphoma), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64704","name":"Revise hand/foot nerve","description":"Neuroplasty; nerve of hand or foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":260.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0160","name":"Sitz type bath or equipment","description":"Sitz type bath or equipment, portable, used with or without commode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45116","name":"Partial removal of rectum","description":"Proctectomy, partial, with anastomosis; transsacral approach only (kraske type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P3000","name":"Screen pap by tech w md supv","description":"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0104","name":"Ca screen;flexi sigmoidscope","description":"Colorectal cancer screening; flexible sigmoidoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0210","name":"Electric heat pad standard","description":"Electric heat pad, standard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5980","name":"Flex foot system","description":"All lower extremity prostheses, flex foot system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2415.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0955","name":"Cushioned headrest","description":"Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93561","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61863","name":"Implant neuroelectrode","description":"Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1260","name":"Anterior thoracic derotation","description":"Addition to tlso, (low profile), anterior thoracic derotation pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97168","name":"Ot re-eval est plan care","description":"Re-evaluation of occupational therapy established plan of care, requiring these components: an assessment of changes in patient functional or medical status with revised plan of care; an update to the initial occupational profile to reflect changes in condition or environment that affect future inte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33364","name":"Replace aortic valve open","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open iliac artery approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95962","name":"Electrode stim brain add-on","description":"Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of attendance by a physician or other qualified health care professional (list separately i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25445","name":"Arthrp w/prostc trapezium","description":"Arthroplasty with prosthetic replacement; trapezium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":605.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90829","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5053","name":"Clsd ostomy pouch faceplate","description":"Ostomy pouch, closed; for use on faceplate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5503","name":"Diabetic shoe w/roller/rockr","description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38792","name":"Ra tracer id of sentinl node","description":"Injection procedure; radioactive tracer for identification of sentinel node","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42725","name":"I&d absc phrngl xtrnl appr","description":"Incision and drainage abscess; retropharyngeal or parapharyngeal, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2340","name":"Pre-tibial shell molded to p","description":"Addition to lower extremity, pre-tibial shell, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69667","name":"Repair middle ear structures","description":"Repair round window fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":651.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47539","name":"Perq plmt bile duct stent","description":"Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; new access,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33362","name":"Replace aortic valve open","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open femoral artery approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1149.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3390","name":"Shoe outflare wedge","description":"Outflare wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87522","name":"Hepatitis c revrs trnscrpj","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis c, quantification, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32505","name":"Wedge resect of lung initial","description":"Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49411","name":"Ins mark abd/pel for rt perq","description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21407","name":"Opn tx orbit fx w/implant","description":"Open treatment of fracture of orbit, except blowout; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":523.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82374","name":"Assay blood carbon dioxide","description":"Carbon dioxide (bicarbonate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21029","name":"Contour of face bone lesion","description":"Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96153","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0762","name":"Trans elec jt stim dev sys","description":"Transcutaneous electrical joint stimulation device system, includes all accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98968","name":"Ph1 assmt&mgmt nqhp 21-30","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31540","name":"Laryngoscopy w/exc of tumor","description":"Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42225","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate; attachment pharyngeal flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23930","name":"I&d upr a/e dp absc/hmtma","description":"Incision and drainage, upper arm or elbow area; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":295.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38746","name":"Remove thoracic lymph nodes","description":"Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6531","name":"Compress stking bk30-40 surg","description":"Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5150","name":"Mold sckt ext knee shin sach","description":"Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1935.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2390","name":"Offset knee joint each","description":"Addition to lower extremity, offset knee joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7041","name":"Water seal drain container","description":"Water seal drainage container and tubing for use with implanted chest tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35697","name":"Reimplant artery each","description":"Reimplantation, visceral artery to infrarenal aortic prosthesis, each artery (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27766","name":"Optx medial ankle fx","description":"Open treatment of medial malleolus fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94644","name":"Cont inhlj tx 1st hour","description":"Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43233","name":"Egd balloon dil esoph30 mm/>","description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7004","name":"Disposable nebulizer sml vol","description":"Small volume nonfiltered pneumatic nebulizer, disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50390","name":"Drainage of kidney lesion","description":"Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69641","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":840.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27455","name":"Realignment of knee","description":"Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); before epiphyseal closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63043","name":"Laminotomy addl cervical","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5964","name":"Above knee flex cover system","description":"Addition, endoskeletal system, above knee, flexible protective outer surface covering system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86305","name":"Human epididymis protein 4","description":"Human epididymis protein 4 (he4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45110","name":"Removal of rectum","description":"Proctectomy; complete, combined abdominoperineal, with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2319","name":"Lens trifocal seg width > 28","description":"Trifocal seg width over 28 mm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71048","name":"X-ray exam chest 4+ views","description":"Radiologic examination, chest; 4 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43020","name":"Incision of esophagus","description":"Esophagotomy, cervical approach, with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":464.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90997","name":"Hemoperfusion","description":"Hemoperfusion (eg, with activated charcoal or resin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64510","name":"N block stellate ganglion","description":"Injection, anesthetic agent; stellate ganglion (cervical sympathetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28705","name":"Arthrodesis pantalar","description":"Arthrodesis; pantalar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69725","name":"Release facial nerve","description":"Decompression facial nerve, intratemporal; including medial to geniculate ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3761","name":"Eo, adj lock joint prefab ot","description":"Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37204","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":957.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4267","name":"Male condom","description":"Contraceptive supply, condom, male, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87490","name":"Chlmyd trach dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia trachomatis, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93724","name":"Elec alys antitchycar pm sys","description":"Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64647","name":"Chemodenerv trunk musc 6/>","description":"Chemodenervation of trunk muscle(s); 6 or more muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82465","name":"Assay bld/serum cholesterol","description":"Cholesterol, serum or whole blood, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22015","name":"I&d abscess p-spine l/s/ls","description":"Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbosacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":820.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64821","name":"Sympathectomy radial artery","description":"Sympathectomy; radial artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70553","name":"Mri brain stem w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4382","name":"Urinary hvy plstc pch w/o fp","description":"Ostomy pouch, urinary, for use on faceplate, heavy plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6533","name":"Gc stocking thighlngth 18-30","description":"Gradient compression stocking, thigh length, 18-30 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4411","name":"Ost skn barr extnd =4sq","description":"Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46761","name":"Repair of anal sphincter","description":"Sphincteroplasty, anal, for incontinence, adult; levator muscle imbrication (park posterior anal repair)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":730.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1710","name":"Legg perthes orth newington","description":"Legg perthes orthosis, (newington type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":832.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82075","name":"Assay of breath ethanol","description":"Alcohol (ethanol); breath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96406","name":"Chemo intralesional over 7","description":"Chemotherapy administration; intralesional, more than 7 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92560","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20550","name":"Njx 1 tendon sheath/ligament","description":"Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2800","name":"Knee cap medial or lateral p","description":"Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20910","name":"Remove cartilage for graft","description":"Cartilage graft; costochondral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92100","name":"Serial tonometry","description":"Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (eg, diurnal curve or medical treatment of acute elevation of intraocular pressure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80306","name":"Drug test prsmv instrmnt","description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; read by instrument assisted direct optical observation (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87152","name":"Culture type pulse field gel","description":"Culture, typing; identification by pulse field gel typing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49500","name":"Rpr ing hernia init reduce","description":"Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":341.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00102","name":"Anes px plstc rpr cleft lip","description":"Anesthesia for procedures involving plastic repair of cleft lip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27665","name":"Repair of leg tendon each","description":"Repair, extensor tendon, leg; secondary, with or without graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":341.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50544","name":"Laparoscopy pyeloplasty","description":"Laparoscopy, surgical; pyeloplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24164","name":"Removal prosth radial head","description":"Removal of prosthesis, includes debridement and synovectomy when performed; radial head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23184","name":"Prtl excision bone prox hum","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), proximal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":621.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90810","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36471","name":"Njx sclrsnt mlt incmptnt vn","description":"Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28310","name":"Revision of big toe","description":"Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46707","name":"Repair anorectal fist w/plug","description":"Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [sis])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":409.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57291","name":"Construction of vagina","description":"Construction of artificial vagina; without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6245","name":"Hydrogel drg <= 16 in w/bdr","description":"Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1405","name":"O2/water vapor enrich w/heat","description":"Oxygen and water vapor enriching system with heated delivery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4538","name":"Diaper serv reusable diaper","description":"Diaper service, reusable diaper, each diaper","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0823","name":"Pwc gp 2 std cap chair","description":"Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86079","name":"Phys blood bank serv authrj","description":"Blood bank physician services; authorization for deviation from standard blood banking procedures (eg, use of outdated blood, transfusion of rh incompatible units), with written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95017","name":"All tstg perq&iq w/venoms","description":"Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95954","name":"Eeg monitoring/giving drugs","description":"Pharmacological or physical activation requiring physician or other qualified health care professional attendance during eeg recording of activation phase (eg, thiopental activation test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27175","name":"Treat slipped epiphysis","description":"Treatment of slipped femoral epiphysis; by traction, without reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":563.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0111","name":"Crutch forearm each","description":"Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49407","name":"Image cath fluid trns/vgnl","description":"Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, transvaginal or transrectal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28003","name":"Treatment of foot infection","description":"Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24360","name":"Reconstruct elbow joint","description":"Arthroplasty, elbow; with membrane (eg, fascial)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78831","name":"Rp loclzj tum spect 2 areas","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect), minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27485","name":"Surgery to stop leg growth","description":"Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or valgus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0835","name":"Pwc gp2 std sing pow opt s/b","description":"Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44390","name":"Colonoscopy for foreign body","description":"Colonoscopy through stoma; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":301.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86337","name":"Insulin antibodies","description":"Insulin antibodies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26842","name":"Thumb fusion with graft","description":"Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4640","name":"Alternating pressure pad","description":"Replacement pad for use with medically necessary alternating pressure pad owned by patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49405","name":"Image cath fluid colxn visc","description":"Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":677.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59622","name":"Attempted vbac after care","description":"Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1170.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5665","name":"Multi-durometer below knee","description":"Addition to lower extremity, socket insert, multi-durometer, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95713","name":"Veeg 2-12 hr cont mntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, 2-12 hours; with continuous, real-time monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83015","name":"Heavy metal qual any number","description":"Heavy metal (eg, antimony, arsenic, barium, beryllium, bismuth, gadolinium, mercury); qualitative, any number of analytes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57540","name":"Removal of residual cervix","description":"Excision of cervical stump, abdominal approach;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5620","name":"Test socket below knee","description":"Addition to lower extremity, test socket, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15940","name":"Exc ischial pr ulc prim sutr","description":"Excision, ischial pressure ulcer, with primary suture;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":460.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87088","name":"Urine bacteria culture","description":"Culture, bacterial; with isolation and presumptive identification of each isolate, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83550","name":"Iron binding test","description":"Iron binding capacity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82528","name":"Assay of corticosterone","description":"Corticosterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24546","name":"Optx hum fx w/ntrcndylr xtn","description":"Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; with intercondylar extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":876.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00880","name":"Anes maj lwr abd vessel nos","description":"Anesthesia for procedures on major lower abdominal vessels; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75893","name":"Venous sampling by catheter","description":"Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65730","name":"Corneal transplant","description":"Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":748.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44312","name":"Revision of ileostomy","description":"Revision of ileostomy; simple (release of superficial scar) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70010","name":"Contrast x-ray of brain","description":"Myelography, posterior fossa, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33512","name":"Cabg vein three","description":"Coronary artery bypass, vein only; 3 coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2102.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90999","name":"Unlisted dialysis procedure","description":"Unlisted dialysis procedure, inpatient or outpatient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95927","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42425","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70170","name":"X-ray exam of tear duct","description":"Dacryocystography, nasolacrimal duct, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95819","name":"Eeg awake and asleep","description":"Electroencephalogram (eeg); including recording awake and asleep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0248","name":"Hdtrans bench w/wo comm open","description":"Transfer bench, heavy duty, for tub or toilet with or without commode opening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61559","name":"Excision of skull/sutures","description":"Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); recontouring with multiple osteotomies and bone autografts (eg, barrel-stave procedure) (includes obtaining grafts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29888","name":"Arthrs aid acl rpr/agmntj","description":"Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82945","name":"Glucose other fluid","description":"Glucose, body fluid, other than blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15953","name":"Exc trchntr pr ulc flp ostc","description":"Excision, trochanteric pressure ulcer, with skin flap closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84160","name":"Assay of protein any source","description":"Protein, total, by refractometry, any source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47555","name":"Biliary endoscopy thru skin","description":"Biliary endoscopy, percutaneous via t-tube or other tract; with dilation of biliary duct stricture(s) without stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87653","name":"Strep b dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); streptococcus, group b, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86317","name":"Immunoassay infectious agent","description":"Immunoassay for infectious agent antibody, quantitative, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87556","name":"M.tuberculo dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria tuberculosis, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0604","name":"Repl batt lithium 3.6 v","description":"Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33775","name":"Rpr tga atr bfl rmvl plm bnd","description":"Repair of transposition of the great arteries, atrial baffle procedure (eg, mustard or senning type) with cardiopulmonary bypass; with removal of pulmonary band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30118","name":"Removal of intranasal lesion","description":"Excision or destruction (eg, laser), intranasal lesion; external approach (lateral rhinotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":579.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58572","name":"Tlh uterus over 250 g","description":"Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":660.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15116","name":"Epdrm agrft f/s/n/h/f/g/m ea","description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75870","name":"Vein x-ray skull","description":"Venography, superior sagittal sinus, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3550","name":"O shoe add standard toe tap","description":"Orthopedic shoe addition, toe tap standard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94777","name":"Ped home apnea mntr rvw i&r","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; review, interpretation and preparation of report only by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00100","name":"Anes px salivary gland w/bx","description":"Anesthesia for procedures on salivary glands, including biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59414","name":"Deliver placenta","description":"Delivery of placenta (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88740","name":"Transcutaneous carboxyhb","description":"Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26392","name":"Repair/graft hand tendon","description":"Removal of synthetic rod and insertion of flexor tendon graft, hand or finger (includes obtaining graft), each rod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8410","name":"Sheath above knee","description":"Prosthetic sheath, above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67227","name":"Dstrj extensive retinopathy","description":"Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), cryotherapy, diathermy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60545","name":"Explore adrenal gland","description":"Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2038","name":"Kafo w/o joint multi-axis an","description":"Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":875.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85060","name":"Blood smear interpretation","description":"Blood smear, peripheral, interpretation by physician with written report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21123","name":"Geniop sldg augmentation","description":"Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":700.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2062","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52001","name":"Cysto w/irrg&evac mlt clots","description":"Cystourethroscopy with irrigation and evacuation of multiple obstructing clots","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83516","name":"Immunoassay nonantibody","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78492","name":"Myocrd img pet mlt rst&strs","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80202","name":"Assay of vancomycin","description":"Vancomycin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26508","name":"Release thumb contracture","description":"Release of thenar muscle(s) (eg, thumb contracture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64642","name":"Chemodenerv 1 extremity 1-4","description":"Chemodenervation of one extremity; 1-4 muscle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94014","name":"Patient recorded spirometry","description":"Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9486","name":"Remote e/m est. pt 10mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward med","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1222","name":"Wheelchair spec size w/ leg","description":"Wheelchair with fixed arm, elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78110","name":"Plasma volume single","description":"Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92575","name":"Sensorineural acuity lvl tst","description":"Sensorineural acuity level test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37185","name":"Prim art m-thrmbc sbsq vsl","description":"Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (list separa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78016","name":"Thyroid met imaging/studies","description":"Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":228.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85290","name":"Clot factor xiii fibrin stab","description":"Clotting; factor xiii (fibrin stabilizing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00620","name":"Anes px thrc spine&cord nos","description":"Anesthesia for procedures on thoracic spine and cord, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76932","name":"Echo guide for heart biopsy","description":"Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67875","name":"Closure of eyelid by suture","description":"Temporary closure of eyelids by suture (eg, frost suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36570","name":"Insert picvad cath","description":"Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1220.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46320","name":"Removal of hemorrhoid clot","description":"Excision of thrombosed hemorrhoid, external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0038","name":"Leg strap each","description":"Leg strap, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64615","name":"Chemodenerv musc migraine","description":"Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76519","name":"Echo exam of eye","description":"Ophthalmic biometry by ultrasound echography, a-scan; with intraocular lens power calculation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25118","name":"Excise wrist tendon sheath","description":"Synovectomy, extensor tendon sheath, wrist, single compartment;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":316.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00860","name":"Anes xtrprtl px lwr abd nos","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75559","name":"Cardiac mri w/stress img","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0189","name":"Lambswool sheepskin pad","description":"Lambswool sheepskin pad, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34708","name":"Evasc rpr ilio-iliac rpt","description":"Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3208","name":"Surgical boot each infant","description":"Surgical boot, each, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80158","name":"Drug assay cyclosporine","description":"Cyclosporine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68850","name":"Injection for tear sac x-ray","description":"Injection of contrast medium for dacryocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59622","name":"Attempted vbac after care","description":"Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72050","name":"X-ray exam neck spine 4/5vws","description":"Radiologic examination, spine, cervical; 4 or 5 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82380","name":"Assay of carotene","description":"Carotene","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61538","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, with electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80178","name":"Assay of lithium","description":"Lithium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47765","name":"Fuse liver ducts & bowel","description":"Anastomosis, of intrahepatic ducts and gastrointestinal tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2559.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1005","name":"Pwr seat recline pwr","description":"Wheelchair accessory, power seating system, recline only, with power shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88239","name":"Tissue culture tumor","description":"Tissue culture for neoplastic disorders; solid tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88375","name":"Optical endomicroscpy interp","description":"Optical endomicroscopic image(s), interpretation and report, real-time or referred, each endoscopic session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54861","name":"Removal of epididymis","description":"Epididymectomy; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":459.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48000","name":"Drainage of abdomen","description":"Placement of drains, peripancreatic, for acute pancreatitis;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1584.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84110","name":"Assay of porphobilinogen","description":"Porphobilinogen, urine; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32505","name":"Wedge resect of lung initial","description":"Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64886","name":"Nerve graft head/neck >4 cm","description":"Nerve graft (includes obtaining graft), head or neck; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6021","name":"Collagen dressing <=16 sq in","description":"Collagen dressing, sterile, size 16 sq. in. or less, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78579","name":"Lung ventilation imaging","description":"Pulmonary ventilation imaging (eg, aerosol or gas)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11426","name":"Exc h-f-nk-sp b9+marg >4 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93922","name":"Upr/l xtremity art 2 levels","description":"Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, doppler waveform recording and analysis at 1-2 levels, or ankle/brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22855","name":"Removal anterior instrmj","description":"Removal of anterior instrumentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0637","name":"Lso sc r ant/pos pnl pre cst","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9984","name":"Remote e/m est. pt  15mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70480","name":"Ct orbit/ear/fossa w/o dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42140","name":"Excision of uvula","description":"Uvulectomy, excision of uvula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50400","name":"Revision of kidney/ureter","description":"Pyeloplasty (foley y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45346","name":"Sigmoidoscopy w/ablation","description":"Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36598","name":"Inj w/fluor eval cv device","description":"Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40819","name":"Excise lip or cheek fold","description":"Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24342","name":"Repair of ruptured tendon","description":"Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":651.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2373","name":"Hand/chin ctrl spec joystick","description":"Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8690","name":"Aud osseo dev, int/ext comp","description":"Auditory osseointegrated device, includes all internal and external components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2317.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77046","name":"Mri breast c- unilateral","description":"Magnetic resonance imaging, breast, without contrast material; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84588","name":"Assay of vasopressin","description":"Vasopressin (antidiuretic hormone, adh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0720","name":"Tens two lead","description":"Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96125","name":"Cognitive test by hc pro","description":"Standardized cognitive performance testing (eg, ross information processing assessment) per hour of a qualified health care professionals time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93460","name":"R&l hrt art/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1296.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26205","name":"Remove/graft bone lesion","description":"Excision or curettage of bone cyst or benign tumor of metacarpal; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78606","name":"Brain image w/flow 4 + views","description":"Brain imaging, minimum 4 static views; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33768","name":"Anast cavopulm sec sup v/c","description":"Anastomosis, cavopulmonary, second superior vena cava (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33995","name":"Insj perq vad r hrt venous","description":"Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43771","name":"Lap revise gastr adj device","description":"Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1070.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48510","name":"Drain pancreatic pseudocyst","description":"External drainage, pseudocyst of pancreas, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64913","name":"Nrv rpr w/nrv algrft ea addl","description":"Nerve repair; with nerve allograft, each additional strand (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98976","name":"Rtm dev sply resp sys 16-30d","description":"Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 16-30 days in a 30-day period","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L1825","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11750","name":"Excision nail&nail matrix","description":"Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4670","name":"Automatic bp monitor, dial","description":"Automatic blood pressure monitor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26520","name":"Release knuckle contracture","description":"Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2227","name":"Gear reduction drive wheel","description":"Manual wheelchair accessory, gear reduction drive wheel, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27132","name":"Total hip arthroplasty","description":"Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1421.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67031","name":"Laser surgery eye strands","description":"Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (1 or more stages)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9868","name":"Cmmi asyntelehealth <10min","description":"Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95913","name":"Nrv cndj test 13/> studies","description":"Nerve conduction studies; 13 or more studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32666","name":"Thoracoscopy w/wedge resect","description":"Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":692.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6630","name":"Stainless steel any wrist","description":"Upper extremity addition, stainless steel, any wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11981","name":"Insertion drug dlvr implant","description":"Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21015","name":"Resect face/scalp tum < 2 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; less than 2 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9984","name":"Remote e/m est. pt  15mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58558","name":"Hysteroscopy biopsy","description":"Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without d & c","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84460","name":"Alanine amino (alt) (sgpt)","description":"Transferase; alanine amino (alt) (sgpt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87207","name":"Smear special stain","description":"Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4396","name":"Static or dynami afo pre cst","description":"Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99315","name":"Nf dschrg mgmt 30 min/less","description":"Nursing facility discharge management; 30 minutes or less total time on the date of the encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2387","name":"Foam filled caster tire","description":"Power wheelchair accessory, foam filled caster tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25280","name":"Revise wrist/forearm tendon","description":"Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28420","name":"Optx calcaneal fx w/bone grf","description":"Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1084.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13133","name":"Cmplx rpr f/c/c/m/n/ax/g/h/f","description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77293","name":"Respirator motion mgmt simul","description":"Respiratory motion management simulation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":359.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7028","name":"Repl oral cushion combo mask","description":"Oral cushion for combination oral/nasal mask, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77057","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0087","name":"Care man home care plan 60 m","description":"Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6890","name":"Prefab glove for term device","description":"Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45388","name":"Colonoscopy w/ablation","description":"Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57282","name":"Colpopexy extraperitoneal","description":"Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01270","name":"Anes px arteries upr leg nos","description":"Anesthesia for procedures involving arteries of upper leg, including bypass graft; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35103","name":"Repair artery rupture aorta","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, hypogastric, external)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1975.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95958","name":"Eeg monitoring/function test","description":"Wada activation test for hemispheric function, including electroencephalographic (eeg) monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2617","name":"Custom fab w/c back cushion","description":"Custom fabricated wheelchair back cushion, any size, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0466","name":"Tlso r fram soft ant pre cst","description":"Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46500","name":"Injection into hemorrhoid(s)","description":"Injection of sclerosing solution, hemorrhoids","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22514","name":"Perq vertebral augmentation","description":"Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93556","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24800","name":"Arthrodesis elbw joint local","description":"Arthrodesis, elbow joint; local","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91120","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68810","name":"Probe nasolacrimal duct","description":"Probing of nasolacrimal duct, with or without irrigation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72198","name":"Mr angio pelvis w/o & w/dye","description":"Magnetic resonance angiography, pelvis, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":305.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73723","name":"Mri joint lwr extr w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2207","name":"Lens sphcy bifocal 4.25-7d/.","description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2510","name":"Sgd w multi methods msg/accs","description":"Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53600","name":"Dilate urethra stricture","description":"Dilation of urethral stricture by passage of sound or urethral dilator, male; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74210","name":"X-ray xm phrnx&/crv esoph c+","description":"Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0548T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83498","name":"Asy hydroxyprogesterone 17-d","description":"Hydroxyprogesterone, 17-d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90869","name":"Tcran magn stim redetemine","description":"Therapeutic repetitive transcranial magnetic stimulation (tms) treatment; subsequent motor threshold re-determination with delivery and management","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64858","name":"Repair sciatic nerve","description":"Suture of sciatic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4356","name":"Ext ureth clmp or compr dvc","description":"External urethral clamp or compression device (not to be used for catheter clamp), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2226","name":"Caster fork replacement only","description":"Manual wheelchair accessory, caster fork, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26215","name":"Remove/graft finger lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82658","name":"Enzyme cell activity ra","description":"Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; radioactive substrate, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1801","name":"Sps/pass elbow device","description":"Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22216","name":"Incis addl spine segment","description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86301","name":"Immunoassay tumor ca 19-9","description":"Immunoassay for tumor antigen, quantitative; ca 19-9","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67314","name":"Revise eye muscle","description":"Strabismus surgery, recession or resection procedure; 1 vertical muscle (excluding superior oblique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84443","name":"Assay thyroid stim hormone","description":"Thyroid stimulating hormone (tsh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4377","name":"Drainable plstic pch w/o fp","description":"Ostomy pouch, drainable, for use on faceplate, plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50945","name":"Laparoscopy ureterolithotomy","description":"Laparoscopy, surgical; ureterolithotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64505","name":"N block spenopalatine gangl","description":"Injection, anesthetic agent; sphenopalatine ganglion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0638","name":"Standing frame sys","description":"Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":581.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4719","name":"Y set tubing","description":"Y set tubing for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87528","name":"Hsv dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); herpes simplex virus, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83498","name":"Asy hydroxyprogesterone 17-d","description":"Hydroxyprogesterone, 17-d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15758","name":"Free fascial flap microvasc","description":"Free fascial flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37180","name":"Revision of circulation","description":"Venous anastomosis, open; splenorenal, proximal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24565","name":"Cltx hum epcndylr fx w/mnpj","description":"Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64776","name":"Remove digit nerve lesion","description":"Excision of neuroma; digital nerve, 1 or both, same digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49185","name":"Sclerotx fluid collection","description":"Sclerotherapy of a fluid collection (eg, lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (eg, ultrasound, fluoroscopy) and radiological supervision and interpretation when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27253","name":"Treat hip dislocation","description":"Open treatment of hip dislocation, traumatic, without internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":798.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87150","name":"Dna/rna amplified probe","description":"Culture, typing; identification by nucleic acid (dna or rna) probe, amplified probe technique, per culture or isolate, each organism probed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69660","name":"Revise middle ear bone","description":"Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92287","name":"Ant sgm img ir flrscn angrph","description":"Anterior segment imaging with interpretation and report; with fluorescein angiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21422","name":"Optx palatal/max fracture","description":"Open treatment of palatal or maxillary fracture (lefort i type);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76827","name":"Echo exam of fetal heart","description":"Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0378T","name":"Visual field assmnt rev/rprt","description":"Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24340","name":"Tenodesis biceps tdn at elbw","description":"Tenodesis of biceps tendon at elbow (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":516.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26862","name":"Fusion/graft of finger joint","description":"Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6500","name":"Above elbow prosth tiss shap","description":"Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1586.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27170","name":"Repair/graft femur head/neck","description":"Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes obtaining bone graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0195","name":"Elevating whlchair leg rests","description":"Elevating leg rests, pair (for use with capped rental wheelchair base)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2300","name":"Abduction bar jointed adjust","description":"Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64570","name":"Remove vagus n eltrd","description":"Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":659.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45560","name":"Repair of rectocele","description":"Repair of rectocele (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4381","name":"Urinary plastic pouch w/o fp","description":"Ostomy pouch, urinary, for use on faceplate, plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67221","name":"Ocular photodynamic ther","description":"Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86510","name":"Histoplasmosis skin test","description":"Skin test; histoplasmosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0437","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00842","name":"Anes iper px amniocentesis","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; amniocentesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56605","name":"Biopsy of vulva/perineum","description":"Biopsy of vulva or perineum (separate procedure); 1 lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37246","name":"Trluml balo angiop 1st art","description":"Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1025.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63290","name":"Bx/exc xdrl/idrl lsn any lvl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2570.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27226","name":"Treat hip wall fracture","description":"Open treatment of posterior or anterior acetabular wall fracture, with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":894.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28122","name":"Partial removal of foot bone","description":"Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":481.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96371","name":"Sc ther infusion reset pump","description":"Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80415","name":"Tot estradiol response panel","description":"Chorionic gonadotropin stimulation panel; estradiol response this panel must include the following: estradiol, total (82670 x 2 on 3 pooled blood samples)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71030","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53460","name":"Revision of urethra","description":"Urethromeatoplasty, with partial excision of distal urethral segment (richardson type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":370.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6410","name":"Sterile eye pad","description":"Eye pad, sterile, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44365","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69150","name":"Extensive ear canal surgery","description":"Radical excision external auditory canal lesion; without neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33465","name":"Replace tricuspid valve","description":"Replacement, tricuspid valve, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2395.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50760","name":"Ureteroureterostomy","description":"Ureteroureterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47361","name":"Repair liver wound","description":"Management of liver hemorrhage; exploration of hepatic wound, extensive debridement, coagulation and/or suture, with or without packing of liver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25690","name":"Cltx lunate dislc w/mnpj","description":"Closed treatment of lunate dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19020","name":"Mastotomy expl drg absc dp","description":"Mastotomy with exploration or drainage of abscess, deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54512","name":"Excise lesion testis","description":"Excision of extraparenchymal lesion of testis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38555","name":"Removal neck/armpit lesion","description":"Excision of cystic hygroma, axillary or cervical; with deep neurovascular dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7002","name":"Tubing used w suction pump","description":"Tubing, used with suction pump, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31087","name":"Removal of frontal sinus","description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, coronal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27499","name":"Decompression of thigh/knee","description":"Decompression fasciotomy, thigh and/or knee, multiple compartments; with debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50600","name":"Exploration of ureter","description":"Ureterotomy with exploration or drainage (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95723","name":"Eeg phy/qhp>60<84 hr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 60 hours, up to 84 hours of eeg recording, without video","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27830","name":"Treat lower leg dislocation","description":"Closed treatment of proximal tibiofibular joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01965","name":"Anes incompl/missed ab px","description":"Anesthesia for incomplete or missed abortion procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58958","name":"Resc recr ovr tbl pp utr mal","description":"Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed, with pelvic lymphadenectomy and limited para-aortic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1118.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22525","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3567.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q4046","name":"Cast sup sht leg splnt fbrgl","description":"Cast supplies, short leg splint, adult (11 years +), fiberglass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77067","name":"Scr mammo bi incl cad","description":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43496","name":"Free jejunum flap microvasc","description":"Free jejunum transfer with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":734.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01234","name":"Anes opn upr 2/3 fem rad res","description":"Anesthesia for open procedures involving upper two-thirds of femur; radical resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90912","name":"Bfb training 1st 15 min","description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including emg and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63308","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; each additional segment (list separately in addition to codes for single segment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74475","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45100","name":"Biopsy of rectum","description":"Biopsy of anorectal wall, anal approach (eg, congenital megacolon)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":239.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65779","name":"Cover eye w/membrane suture","description":"Placement of amniotic membrane on the ocular surface; single layer, sutured","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":750.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70547","name":"Mr angiography neck w/o dye","description":"Magnetic resonance angiography, neck; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99186","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38204","name":"Bl donor search management","description":"Management of recipient hematopoietic progenitor cell donor search and cell acquisition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0147","name":"Scr c/v cyto, automated sys","description":"Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0248","name":"Demonstrate use home inr mon","description":"Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43195","name":"Esophagoscopy rigid balloon","description":"Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77772","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01926","name":"Anes ivntl rad icr icar/aort","description":"Anesthesia for therapeutic interventional radiological procedures involving the arterial system; intracranial, intracardiac, or aortic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48540","name":"Fuse pancreas cyst and bowel","description":"Internal anastomosis of pancreatic cyst to gastrointestinal tract; roux-en-y","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0184","name":"Dry pressure mattress","description":"Dry pressure mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93543","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33427","name":"Repair of mitral valve","description":"Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2121.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27720","name":"Repair of tibia","description":"Repair of nonunion or malunion, tibia; without graft, (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0854","name":"Pwc gp 3 xhd seat/back","description":"Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37160","name":"Revision of circulation","description":"Venous anastomosis, open; caval-mesenteric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0857","name":"Pwc gp3 std sing pow opt cap","description":"Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92561","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2305","name":"Lens sphcy trifocal 4.0/4.25","description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00 cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42227","name":"Lengthening of palate","description":"Lengthening of palate, with island flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92970","name":"Cardioassist internal","description":"Cardioassist-method of circulatory assist; internal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17107","name":"Dstr cut vsc prlf les10-50sq","description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":277.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48140","name":"Partial removal of pancreas","description":"Pancreatectomy, distal subtotal, with or without splenectomy; without pancreaticojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1305.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64784","name":"Remove nerve lesion","description":"Excision of neuroma; major peripheral nerve, except sciatic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36556","name":"Insert non-tunnel cv cath","description":"Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93457","name":"R hrt art/grft angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injecti","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40844","name":"Reconstruction of mouth","description":"Vestibuloplasty; entire arch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1182.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78466","name":"Heart infarct image","description":"Myocardial imaging, infarct avid, planar; qualitative or quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11451","name":"Exc skn hdrdnt ax complex","description":"Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35701","name":"Expl n/flwd surg neck art","description":"Exploration not followed by surgical repair, artery; neck (eg, carotid, subclavian)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86902","name":"Blood type antigen donor ea","description":"Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0016","name":"Alcohol and/or drug services","description":"Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30400","name":"Reconstruction of nose","description":"Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78761","name":"Testicular imaging w/flow","description":"Testicular imaging with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72132","name":"Ct lumbar spine w/dye","description":"Computed tomography, lumbar spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37200","name":"Transcatheter biopsy","description":"Transcatheter biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43101","name":"Excision of esophagus lesion","description":"Excision of lesion, esophagus, with primary repair; thoracic or abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":830.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92285","name":"External ocular photography","description":"External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, slit lamp photography, goniophotography, stereo-photography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82507","name":"Assay of citrate","description":"Citrate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31510","name":"Laryngoscopy with biopsy","description":"Laryngoscopy, indirect; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0700","name":"Safety equipment","description":"Safety equipment, device or accessory, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54437","name":"Repair corporeal tear","description":"Repair of traumatic corporeal tear(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":545.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0235","name":"Paraffin bath unit portable","description":"Paraffin bath unit, portable (see medical supply code a4265 for paraffin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45800","name":"Repair rect/bladder fistula","description":"Closure of rectovesical fistula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1960","name":"Afo pos solid ank plastic mo","description":"Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4396","name":"Static or dynami afo pre cst","description":"Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0849","name":"Cervical pneum trac equip","description":"Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8990","name":"Pt or manip for maint","description":"Physical or manipulative therapy performed for maintenance rather than restoration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36522","name":"Photopheresis","description":"Photopheresis, extracorporeal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1551.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86671","name":"Fungus nes antibody","description":"Antibody; fungus, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0462","name":"Tlso 3mod sacro-scap pre","description":"Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46020","name":"Placement of seton","description":"Placement of seton","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72131","name":"Ct lumbar spine w/o dye","description":"Computed tomography, lumbar spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44156","name":"Removal of colon/ileostomy","description":"Colectomy, total, abdominal, with proctectomy; with continent ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1935.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76125","name":"Cine/video x-rays add-on","description":"Cineradiography/videoradiography to complement routine examination (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58770","name":"Create new tubal opening","description":"Salpingostomy (salpingoneostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64461","name":"Pvb thoracic single inj site","description":"Paravertebral block (pvb) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44020","name":"Explore small intestine","description":"Enterotomy, small intestine, other than duodenum; for exploration, biopsy(s), or foreign body removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":812.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27570","name":"Fixation of knee joint","description":"Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93017","name":"Cv stress test tracing only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99402","name":"Prev med cnsl indiv apprx 30","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83891","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60522","name":"Removal of thymus gland","description":"Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1180.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0452","name":"Tlso flex custom fab thoraci","description":"Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27686","name":"Revise lower leg tendons","description":"Lengthening or shortening of tendon, leg or ankle; multiple tendons (through same incision), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":448.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57061","name":"Destruction vag lesions smpl","description":"Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92971","name":"Cardioassist external","description":"Cardioassist-method of circulatory assist; external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5981","name":"Flex-walk sys low ext prosth","description":"All lower extremity prostheses, flex-walk system or equal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24076","name":"Ex arm/elbow tum deep < 5 cm","description":"Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0473T","name":"Reprgrmg io rta eltrd ra","description":"Device evaluation and interrogation of intraocular retinal electrode array (eg, retinal prosthesis), in person, including reprogramming and visual training, when performed, with review and report by a qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8683","name":"Radiofq trsmtr for implt neu","description":"Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2556.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62304","name":"Myelography lumbar injection","description":"Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75565","name":"Card mri veloc flow mapping","description":"Cardiac magnetic resonance imaging for velocity flow mapping (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8686","name":"Implt nrostm pls gen sng non","description":"Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25391","name":"Lengthen radius or ulna","description":"Osteoplasty, radius or ulna; lengthening with autograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33274","name":"Tcat insj/rpl perm ldls pm","description":"Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23101","name":"Arthrt acrmclv/strnclav jt","description":"Arthrotomy, acromioclavicular joint or sternoclavicular joint, including biopsy and/or excision of torn cartilage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1830","name":"Ko immob canvas long pre ots","description":"Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36416","name":"Collj capillary blood spec","description":"Collection of capillary blood specimen (eg, finger, heel, ear stick)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84112","name":"Eval amniotic fluid protein","description":"Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (eg, placental alpha microglobulin-1 [pamg-1], placental protein 12 [pp12], alpha-fetoprotein), qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59851","name":"Induced abortion 1+njx d&c","description":"Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28102","name":"Remove/graft foot lesion","description":"Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43500","name":"Surgical opening of stomach","description":"Gastrotomy; with exploration or foreign body removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36466","name":"Njx noncmpnd sclrsnt mlt vn","description":"Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92524","name":"Behavral qualit analys voice","description":"Behavioral and qualitative analysis of voice and resonance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4531","name":"Ped size pull-on sm/med","description":"Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74178","name":"Ct abd&plv wo cntr flwd cntr","description":"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8627","name":"Cid ext speech process repl","description":"Cochlear implant, external speech processor, component, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54500","name":"Biopsy of testis","description":"Biopsy of testis, needle (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69100","name":"Biopsy of external ear","description":"Biopsy external ear","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6940","name":"Elbow disarticulation switch","description":"Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42842","name":"Extensive surgery of throat","description":"Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; without closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":781.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5639","name":"Below knee wood socket","description":"Addition to lower extremity, below knee, wood socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":709.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0761","name":"Nontherm electromgntc device","description":"Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26580","name":"Repair cleft hand","description":"Repair cleft hand","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92082","name":"Intermediate visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on goldmann perimeter, or semiquantitative, automated suprathreshold screening program, humphrey suprathreshold automatic diagnostic test, octopus program 33)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83700","name":"Lipopro bld electrophoretic","description":"Lipoprotein, blood; electrophoretic separation and quantitation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21390","name":"Opn tx orbit periorbtl implt","description":"Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22865","name":"Rmvl tot arthrp 1ntrspc lmbr","description":"Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23180","name":"Prtl excision bone clavicle","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), clavicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90838","name":"Psytx w pt w e/m 60 min","description":"Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (list separately in addition to the code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21087","name":"Impres&prep nasal prosth","description":"Impression and custom preparation; nasal prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93261","name":"Interrogate subq defib","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36500","name":"Insertion of catheter vein","description":"Venous catheterization for selective organ blood sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81236","name":"Ezh2 gene full gene sequence","description":"Ezh2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, myelodysplastic syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0084","name":"Care man h v ext pt 60 m","description":"Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3975","name":"Sewhfo cap design w/o jnt cf","description":"Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6584","name":"Elbow fair lead cable molded","description":"Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1043.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92978","name":"Endoluminl ivus oct c 1st","description":"Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (list separately in addition to code for p","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27269","name":"Optx thigh fx","description":"Open treatment of femoral fracture, proximal end, head, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31382","name":"Partial removal of larynx","description":"Partial laryngectomy (hemilaryngectomy); antero-latero-vertical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1584.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15003","name":"Wound prep addl 100 cm","description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35480","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":573.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73206","name":"Ct angio upr extrm w/o&w/dye","description":"Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67227","name":"Dstrj extensive retinopathy","description":"Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), cryotherapy, diathermy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63087","name":"Remov vertbr dcmprn thrclmbr","description":"Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99471","name":"Ped critical care initial","description":"Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33363","name":"Replace aortic valve open","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open axillary artery approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1191.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95934","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17111","name":"Destruction b9 lesions 15/>","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43644","name":"Lap gastric bypass/roux-en-y","description":"Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and roux-en-y gastroenterostomy (roux limb 150 cm or less)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94727","name":"Gas dil/wshot deter lng vol","description":"Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33645","name":"Revision of heart veins","description":"Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1505.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27709","name":"Osteotomy tibia & fibula","description":"Osteotomy; tibia and fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":984.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11975","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46930","name":"Destroy internal hemorrhoids","description":"Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6616","name":"Disconnect insert locking wr","description":"Upper extremity addition, additional disconnect insert for locking wrist unit, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0705","name":"Transfer device","description":"Transfer device, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67900","name":"Repair brow defect","description":"Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64858","name":"Repair sciatic nerve","description":"Suture of sciatic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":998.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84302","name":"Assay of sweat sodium","description":"Sodium; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40500","name":"Partial excision of lip","description":"Vermilionectomy (lip shave), with mucosal advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4425","name":"Ost pch drain for barrier fl","description":"Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22595","name":"Arthrd pst tq atlas-axis","description":"Arthrodesis, posterior technique, atlas-axis (c1-c2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1349.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27501","name":"Treatment of thigh fracture","description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19285","name":"Perq dev breast 1st us imag","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82955","name":"Assay of g6pd enzyme","description":"Glucose-6-phosphate dehydrogenase (g6pd); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59151","name":"Treat ectopic pregnancy","description":"Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":680.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33675","name":"Close mult vsd","description":"Closure of multiple ventricular septal defects;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88143","name":"Cytopath c/v thin layer redo","description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74263","name":"Ct colonography screening","description":"Computed tomographic (ct) colonography, screening, including image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9604","name":"One-way allow prorated trip","description":"Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72084","name":"X-ray exam entire spi 6/> vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); minimum of 6 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99363","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33610","name":"Repair by enlargement","description":"Repair of complex cardiac anomalies (eg, single ventricle with subaortic obstruction) by surgical enlargement of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33516","name":"Cabg vein six or more","description":"Coronary artery bypass, vein only; 6 or more coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83525","name":"Assay of insulin","description":"Insulin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27252","name":"Treat hip dislocation","description":"Closed treatment of hip dislocation, traumatic; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76805","name":"Ob us >/= 14 wks sngl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q4046","name":"Cast sup sht leg splnt fbrgl","description":"Cast supplies, short leg splint, adult (11 years +), fiberglass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39540","name":"Repair of diaphragm hernia","description":"Repair, diaphragmatic hernia (other than neonatal), traumatic; acute","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":757.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95863","name":"Needle emg 3 extremities","description":"Needle electromyography; 3 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66605","name":"Removal of iris","description":"Iridectomy, with corneoscleral or corneal section; with cyclectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98962","name":"Edu&trn pt slf-mgmt nqhp 5-8","description":"Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61710","name":"Revise circulation to head","description":"Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intra-arterial embolization, injection procedure, or balloon catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00770","name":"Anes px maj abd blood vessel","description":"Anesthesia for all procedures on major abdominal blood vessels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71130","name":"X-ray strenoclavic jt 3/>vws","description":"Radiologic examination; sternoclavicular joint or joints, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86701","name":"Hiv-1antibody","description":"Antibody; hiv-1","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84577","name":"Assay of feces/urobilinogen","description":"Urobilinogen, feces, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33969","name":"Ecmo/ecls rmvl perph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":237.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2622","name":"Hip joint adjustable flexion","description":"Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23931","name":"I&d upr a/e bursa","description":"Incision and drainage, upper arm or elbow area; bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":237.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44158","name":"Colectomy w/neo-rectum pouch","description":"Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (s or j), includes loop ileostomy, and rectal mucosectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1882.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00750","name":"Anes hrna rpr upr abd nos","description":"Anesthesia for hernia repairs in upper abdomen; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71271","name":"Ct thorax lung cancer scr c-","description":"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76940","name":"Us guide tissue ablation","description":"Ultrasound guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0149","name":"Heavy duty wheeled walker","description":"Walker, heavy duty, wheeled, rigid or folding, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38381","name":"Thoracic duct procedure","description":"Suture and/or ligation of thoracic duct; thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":534.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54865","name":"Explore epididymis","description":"Exploration of epididymis, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57288","name":"Repair bladder defect","description":"Sling operation for stress incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99292","name":"Critical care addl 30 min","description":"Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01464","name":"Anes arthrs px ankle&/foot","description":"Anesthesia for arthroscopic procedures of ankle and/or foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0604","name":"Hosp grade elec breast pump","description":"Breast pump, hospital grade, electric (ac and / or dc), any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20924","name":"Removal of tendon for graft","description":"Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0562","name":"Humidifier heated used w pap","description":"Humidifier, heated, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33535","name":"Cabg arterial three","description":"Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2132.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5331","name":"Hip disart canadian sach ft","description":"Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2307.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40830","name":"Repair mouth laceration","description":"Closure of laceration, vestibule of mouth; 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":218.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42280","name":"Preparation palate mold","description":"Maxillary impression for palatal prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":135.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1841","name":"Sps/pass shoulder device","description":"Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63103","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic or lumbar, each additional segment (list separately in addition to code for primary proc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20550","name":"Njx 1 tendon sheath/ligament","description":"Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28309","name":"Incision of metatarsals","description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (eg, swanson type cavus foot procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":725.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50328","name":"Prep renal graft/arterial","description":"Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; arterial anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65114","name":"Remove eye/revise socket","description":"Exenteration of orbit (does not include skin graft), removal of orbital contents; with muscle or myocutaneous flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":923.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86684","name":"Hemophilus influenza antibdy","description":"Antibody; haemophilus influenza","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48154","name":"Pancreatectomy","description":"Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, whipple-type procedure); without pancreatojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2441.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57284","name":"Repair paravag defect open","description":"Paravaginal defect repair (including repair of cystocele, if performed); open abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26442","name":"Release palm & finger tendon","description":"Tenolysis, flexor tendon; palm and finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":800.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10035","name":"Plmt sft tiss loclzj dev 1st","description":"Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92579","name":"Visual audiometry (vra)","description":"Visual reinforcement audiometry (vra)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97608","name":"Neg prs wnd ther ndme>50sqcm","description":"Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surfac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81020","name":"Urinalysis glass test","description":"Urinalysis; 2 or 3 glass test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93892","name":"Tcd emboli detect w/o inj","description":"Transcranial doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45378","name":"Diagnostic colonoscopy","description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","53",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7185","name":"Electron elbow adolescent sw","description":"Electronic elbow, adolescent, variety village or equal, switch controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3557.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33365","name":"Replace aortic valve open","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1258.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95716","name":"Veeg ea 12-26hr cont mntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25660","name":"Cltx rdcrpl/ntrcrpl dislc 1+","description":"Closed treatment of radiocarpal or intercarpal dislocation, 1 or more bones, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":347.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11603","name":"Exc tr-ext mal+marg 2.1-3 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94728","name":"Airwy resist by oscillometry","description":"Airway resistance by oscillometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21470","name":"Optx complicated mndblr fx","description":"Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":955.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33244","name":"Remove elctrd transvenously","description":"Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":747.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86406","name":"Particle agglut antbdy titr","description":"Particle agglutination; titer, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29345","name":"Application of long leg cast","description":"Application of long leg cast (thigh to toes);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92620","name":"Auditory function 60 min","description":"Evaluation of central auditory function, with report; initial 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0210","name":"Electric heat pad standard","description":"Electric heat pad, standard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00320","name":"Anes all px neck nos 1yr/>","description":"Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6258","name":"Transparent film >16<=48 in","description":"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP12","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38380","name":"Thoracic duct procedure","description":"Suture and/or ligation of thoracic duct; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":362.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67445","name":"Explr/decompress eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); with removal of bone for decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":888.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36906","name":"Thrmbc/nfs dialysis circuit","description":"Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thromboly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47537","name":"Removal biliary drg cath","description":"Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":345.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57270","name":"Repair of bowel pouch","description":"Repair of enterocele, abdominal approach (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":517.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85675","name":"Thrombin time titer","description":"Thrombin time; titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96413","name":"Chemo iv infusion 1 hr","description":"Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93981","name":"Penile vascular study","description":"Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3300","name":"Sho lift taper to metatarsal","description":"Lift, elevation, heel, tapered to metatarsals, per inch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35473","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2273.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64624","name":"Dstrj nulyt agt gnclr nrv","description":"Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":326.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78801","name":"Rp loclzj tum 2+area 1+d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0710","name":"Restraints any type","description":"Restraints, any type (body, chest, wrist or ankle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70558","name":"Mri brain w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13122","name":"Cmplx rpr s/a/l addl 5 cm/>","description":"Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84443","name":"Assay thyroid stim hormone","description":"Thyroid stimulating hormone (tsh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23077","name":"Rad rescj tum shoulder<5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31020","name":"Exploration maxillary sinus","description":"Sinusotomy, maxillary (antrotomy); intranasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":354.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0238","name":"Oth resp proc, indiv","description":"Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55862","name":"Extensive prostate surgery","description":"Exposure of prostate, any approach, for insertion of radioactive substance; with lymph node biopsy(s) (limited pelvic lymphadenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84540","name":"Assay of urine/urea-n","description":"Urea nitrogen, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72082","name":"X-ray exam entire spi 2/3 vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4918","name":"Venous pressure clamp","description":"Venous pressure clamp, for hemodialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33916","name":"Surgery of great vessel","description":"Pulmonary endarterectomy, with or without embolectomy, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3695.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67225","name":"Eye photodynamic ther add-on","description":"Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy, second eye, at single session (list separately in addition to code for primary eye treatment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84105","name":"Assay of urine phosphorus","description":"Phosphorus inorganic (phosphate); urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93460","name":"R&l hrt art/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75685","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4522","name":"Adult size brief/diaper med","description":"Adult sized disposable incontinence product, brief/diaper, medium, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5986","name":"Multi-axial rotation unit","description":"All lower extremity prostheses, multi-axial rotation unit (mcp or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":314.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77523","name":"Proton trmt intermediate","description":"Proton treatment delivery; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":703.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74329","name":"X-ray for pancreas endoscopy","description":"Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87487","name":"Chlmyd pneum dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia pneumoniae, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0087","name":"Care man home care plan 60 m","description":"Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84235","name":"Assay of endocrine hormone","description":"Receptor assay; endocrine, other than estrogen or progesterone (specify hormone)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86817","name":"Hla typing dr/dq","description":"Hla typing; dr/dq, multiple antigens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24101","name":"Arthrt elbw jt expl bx rmvl","description":"Arthrotomy, elbow; with joint exploration, with or without biopsy, with or without removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0316","name":"Bed safety enclosure","description":"Safety enclosure frame/canopy for use with hospital bed, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69650","name":"Stapes mobilization","description":"Stapes mobilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54135","name":"Remove penis & nodes","description":"Amputation of penis, radical; in continuity with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1223.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36469","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63301","name":"Remove vert xdrl body thrc","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2020.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47553","name":"Biliary endoscopy thru skin","description":"Biliary endoscopy, percutaneous via t-tube or other tract; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":211.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99307","name":"Sbsq nf care sf mdm 10","description":"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 10 minutes must be met or e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38206","name":"Harvest auto stem cells","description":"Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95973","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83914","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49428","name":"Ligation of shunt","description":"Ligation of peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32440","name":"Remove lung pneumonectomy","description":"Removal of lung, pneumonectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94776","name":"Ped home apnea mntr dl&alys","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitoring, download of information, receipt of transmission(s) and analyses by computer only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":168.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9979","name":"Remote e/m new pt 20mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: an expanded problem focused history;  an expanded problem focused e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92970","name":"Cardioassist internal","description":"Cardioassist-method of circulatory assist; internal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64802","name":"Sympathectomy cervical","description":"Sympathectomy, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32659","name":"Thoracoscopy w/sac drainage","description":"Thoracoscopy, surgical; with creation of pericardial window or partial resection of pericardial sac for drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":582.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99483","name":"Assmt & care pln pt cog imp","description":"Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: cognition-focused evaluation including a pertinent history and examination, m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30920","name":"Ligation upper jaw artery","description":"Ligation arteries; internal maxillary artery, transantral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":638.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2619","name":"Replace cover w/c seat cush","description":"Replacement cover for wheelchair seat cushion or back cushion, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92133","name":"Cptrzd oph dx img pst sgm on","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), posterior segment, with interpretation and report, unilateral or bilateral; optic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21210","name":"Face bone graft","description":"Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36456","name":"Prtl exchange transfuse nb","description":"Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional, newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81539","name":"Oncology prostate prob score","description":"Oncology (high-grade prostate cancer), biochemical assay of four proteins (total psa, free psa, intact psa, and human kallikrein-2 [hk2]), utilizing plasma or serum, prognostic algorithm reported as a probability score","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":380.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17284","name":"Dstr mal ls f/e/e/n/l/m3.1-4","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95872","name":"Ndl emg single fiber eltrd","description":"Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31725","name":"Clearance of airways","description":"Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedside","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33622","name":"Redo compl cardiac anomaly","description":"Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3001.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96150","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61001","name":"Remove cranial cavity fluid","description":"Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73221","name":"Mri joint upr extrem w/o dye","description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46288","name":"Repair anal fistula","description":"Closure of anal fistula with rectal advancement flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71552","name":"Mri chest w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82270","name":"Occult blood feces","description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30130","name":"Excise inferior turbinate","description":"Excision inferior turbinate, partial or complete, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50340","name":"Recipient nephrectomy","description":"Recipient nephrectomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54231","name":"Dynamic cavernosometry","description":"Dynamic cavernosometry, including intracavernosal injection of vasoactive drugs (eg, papaverine, phentolamine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4750","name":"Art or venous blood tubing","description":"Blood tubing, arterial or venous, for hemodialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1832","name":"Ko adj jnt pos r sup pre cst","description":"Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82360","name":"Calculus assay quant","description":"Calculus; quantitative analysis, chemical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2521","name":"Cntct lens hydrophilic toric","description":"Contact lens, hydrophilic, toric, or prism ballast, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1755","name":"Legg perthes patten bottom t","description":"Legg perthes orthosis, (patten bottom type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4530","name":"Ped size brief/diaper lg","description":"Pediatric sized disposable incontinence product, brief/diaper, large size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0400","name":"Home sleep test/type 4 porta","description":"Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73701","name":"Ct lower extremity w/dye","description":"Computed tomography, lower extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51920","name":"Close bladder-uterus fistula","description":"Closure of vesicouterine fistula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":617.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78806","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":269.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70559","name":"Mri brain w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87278","name":"Legion pneumophilia ag if","description":"Infectious agent antigen detection by immunofluorescent technique; legionella pneumophila","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33956","name":"Ecmo/ecls insj ctr cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00625","name":"Anes thrc spine wo 1lng vent","description":"Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; not utilizing 1 lung ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0974","name":"Tlso full corset","description":"Tlso, full corset","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37242","name":"Vasc embolize/occlude artery","description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malfo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3798.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97004","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94610","name":"Intrapulm surfactant admn","description":"Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57310","name":"Repair urethrovaginal lesion","description":"Closure of urethrovaginal fistula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":298.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88302","name":"Tissue exam by pathologist","description":"Level ii - surgical pathology, gross and microscopic examination appendix, incidental fallopian tube, sterilization fingers/toes, amputation, traumatic foreskin, newborn hernia sac, any location hydrocele sac nerve skin, plastic repair sympathetic ganglion testis, castration vaginal mucosa, incident","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78650","name":"Csf leakage imaging","description":"Cerebrospinal fluid leakage detection and localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50081","name":"Perq nl/pl lithotrp cplx>2cm","description":"Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; complex (eg, stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, co","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1034.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72170","name":"X-ray exam of pelvis","description":"Radiologic examination, pelvis; 1 or 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88262","name":"Chromosome analysis 15-20","description":"Chromosome analysis; count 15-20 cells, 2 karyotypes, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4080","name":"Repl met band kafo-afo prox","description":"Replace metal bands kafo, proximal thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93268","name":"Ecg record/review","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, review and interpretation by a physician or other qualified hea","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":196.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78262","name":"Gastroesophageal reflux std","description":"Gastroesophageal reflux study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0601","name":"Repl batt silver oxide 1.5 v","description":"Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26727","name":"Treat finger fracture each","description":"Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30545","name":"Rpr choanal atresia trsnpltn","description":"Repair choanal atresia; transpalatine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":725.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43248","name":"Egd guide wire insertion","description":"Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":298.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84525","name":"Urea nitrogen semi-quant","description":"Urea nitrogen; semiquantitative (eg, reagent strip test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95712","name":"Veeg 2-12 hr intmt mntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, 2-12 hours; with intermittent monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33971","name":"Aortic circulation assist","description":"Removal of intra-aortic balloon assist device including repair of femoral artery, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25136","name":"Remove & graft wrist lesion","description":"Excision or curettage of bone cyst or benign tumor of carpal bones; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61001","name":"Remove cranial cavity fluid","description":"Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84030","name":"Assay of blood pku","description":"Phenylalanine (pku), blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78458","name":"Ven thrombosis images bilat","description":"Venous thrombosis imaging, venogram; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6197","name":"Alginate drsg >16 <=48 sq in","description":"Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G9042","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0473","name":"Group behave couns 2-10","description":"Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70555","name":"Fmri brain by phys/psych","description":"Magnetic resonance imaging, brain, functional mri; requiring physician or psychologist administration of entire neurofunctional testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31267","name":"Endoscopy maxillary sinus","description":"Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86834","name":"Hla class i semiquant panel","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); semi-quantitative panel (eg, titer), hla class i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72141","name":"Mri neck spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25270","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29085","name":"Appl cast hand&lwr forearm","description":"Application, cast; hand and lower forearm (gauntlet)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65820","name":"Goniotomy","description":"Goniotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76700","name":"Us exam abdom complete","description":"Ultrasound, abdominal, real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00640","name":"Anes spine manipulation","description":"Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58140","name":"Myomectomy abdom method","description":"Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":598.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80055","name":"Obstetric panel","description":"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 (85007 or 85009) hepatitis b surface antigen (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29125","name":"Appl short arm splint static","description":"Application of short arm splint (forearm to hand); static","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97110","name":"Therapeutic exercises","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0631","name":"Lso sag r an/pos pnl pre cst","description":"Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31500","name":"Insert emergency airway","description":"Intubation, endotracheal, emergency procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78185","name":"Spleen imaging","description":"Spleen imaging only, with or without vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86360","name":"T cell absolute count/ratio","description":"T cells; absolute cd4 and cd8 count, including ratio","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99245","name":"Off/op consltj new/est hi 55","description":"Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20102","name":"Expl pentrg wnd abd/flnk/bk","description":"Exploration of penetrating wound (separate procedure); abdomen/flank/back","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64580","name":"Opn impltj nea neuromuscular","description":"Open implantation of neurostimulator electrode array; neuromuscular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87449","name":"Nos each organism ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; not otherwise specified, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00600","name":"Anes px crv spine&cord nos","description":"Anesthesia for procedures on cervical spine and cord; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59856","name":"Induced ab 1+vag supp d&c","description":"Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66985","name":"Insert lens prosthesis","description":"Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96522","name":"Refill/maint pump/resvr syst","description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0145T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":258.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31623","name":"Dx bronchoscope/brush","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37217","name":"Stent placemt retro carotid","description":"Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":945.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4253","name":"Blood glucose/reagent strips","description":"Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95905","name":"Motor &/ sens nrve cndj test","description":"Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes f-wave study when performed, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67340","name":"Revise eye muscle add-on","description":"Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27603","name":"Drain lower leg lesion","description":"Incision and drainage, leg or ankle; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":443.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86481","name":"Tb ag response t-cell susp","description":"Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing t-cells in cell suspension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61321","name":"Crnec/crnot drg icr abs ittl","description":"Craniectomy or craniotomy, drainage of intracranial abscess; infratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1810","name":"Adjust knee ext & flex dev","description":"Dynamic adjustable knee extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6680","name":"Test sock wrist disart/bel e","description":"Upper extremity addition, test socket, wrist disarticulation or below elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26180","name":"Removal of finger tendon","description":"Excision of tendon, finger, flexor or extensor, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31579","name":"Laryngoscopy telescopic","description":"Laryngoscopy, flexible or rigid telescopic, with stroboscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6120","name":"Elbow mold doub splt soc ste","description":"Below elbow, molded double wall split socket, step-up hinges, half cuff","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22802","name":"Arthrd pst dfrm 7-12 vrt sgm","description":"Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67971","name":"Reconstruction of eyelid","description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81514","name":"Nfct ds bv&vaginitis dna alg","description":"Infectious disease, bacterial vaginosis and vaginitis, quantitative real-time amplification of dna markers for gardnerella vaginalis, atopobium vaginae, megasphaera type 1, bacterial vaginosis associated bacteria-2 (bvab-2), and lactobacillus species (l. crispatus and l. jensenii), utilizing vaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63077","name":"Spine disk surgery thorax","description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, single interspace","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1327.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22551","name":"Arthrd ant ntrbdy cervical","description":"Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below c2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36561","name":"Insert tunneled cv cath","description":"Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":875.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00148","name":"Anes px eye ophthalmoscopy","description":"Anesthesia for procedures on eye; ophthalmoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64714","name":"Revise low back nerve(s)","description":"Neuroplasty, major peripheral nerve, arm or leg, open; lumbar plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21750","name":"Repair of sternum separation","description":"Closure of median sternotomy separation with or without debridement (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":587.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27147","name":"Revision of hip bone","description":"Osteotomy, iliac, acetabular or innominate bone; with open reduction of hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0842","name":"Pwc gp2 std mult pow opt cap","description":"Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35691","name":"Art trnsposj vertbrl carotid","description":"Transposition and/or reimplantation; vertebral to carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94640","name":"Airway inhalation treatment","description":"Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (ippb) device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87636","name":"Sarscov2 & inf a&b amp prb","description":"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) and influenza virus types a and b, multiplex amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1760","name":"Closure dev, vasc","description":"Closure device, vascular (implantable/insertable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87252","name":"Virus inoculation tissue","description":"Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31640","name":"Bronchoscopy w/tumor excise","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with excision of tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95782","name":"Polysom <6 yrs 4/> paramtrs","description":"Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11732","name":"Avlsn nail plate simple each","description":"Avulsion of nail plate, partial or complete, simple; each additional nail plate (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67221","name":"Ocular photodynamic ther","description":"Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21206","name":"Reconstruct upper jaw bone","description":"Osteotomy, maxilla, segmental (eg, wassmund or schuchard)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":915.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33368","name":"Replace aortic valve w/byp","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":649.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46258","name":"Remove in/ex hem grp w/fistu","description":"Hemorrhoidectomy, internal and external, single column/group; with fistulectomy, including fissurectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88305","name":"Tissue exam by pathologist","description":"Level iv - surgical pathology, gross and microscopic examination abortion - spontaneous/missed artery, biopsy bone marrow, biopsy bone exostosis brain/meninges, other than for tumor resection breast, biopsy, not requiring microscopic evaluation of surgical margins breast, reduction mammoplasty bronc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67112","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":784.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0323","name":"Care manage beh svs 20mins","description":"Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-u","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37202","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":255.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0455","name":"Pump uninterrupted infusion","description":"Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25125","name":"Remove/graft forearm lesion","description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28825","name":"Partial amputation of toe","description":"Amputation, toe; interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33517","name":"Cabg artery-vein single","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":163.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17272","name":"Dstr mal les s/n/h/f/g 1.1-2","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6635","name":"Lift assist for elbow","description":"Upper extremity addition, lift assist for elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50389","name":"Remove renal tube w/fluoro","description":"Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":302.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78645","name":"Csf shunt evaluation","description":"Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78202","name":"Liver imaging with vasc flow","description":"Liver imaging; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6266","name":"Impreg gauze no h20/sal/yard","description":"Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73115","name":"Contrast x-ray of wrist","description":"Radiologic examination, wrist, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86631","name":"Chlamydia antibody","description":"Antibody; chlamydia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67120","name":"Remove eye implant material","description":"Removal of implanted material, posterior segment; extraocular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":403.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4261","name":"Cervical cap contraceptive","description":"Cervical cap for contraceptive use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58974","name":"Embryo transfer intrauterine","description":"Embryo transfer, intrauterine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22100","name":"Remove part of neck vertebra","description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":744.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11950","name":"Subq njx filling matrl 1cc/<","description":"Subcutaneous injection of filling material (eg, collagen); 1 cc or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24344","name":"Reconstruct elbow lat ligmnt","description":"Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59151","name":"Treat ectopic pregnancy","description":"Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35184","name":"Rpr cgen av fistula xtr","description":"Repair, congenital arteriovenous fistula; extremities","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":850.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11313","name":"Shave skin lesion >2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59852","name":"Induced abortion 1+njx hyst","description":"Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed intra-amniotic injection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":504.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50396","name":"Measure kidney pressure","description":"Manometric studies through nephrostomy or pyelostomy tube, or indwelling ureteral catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92226","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72195","name":"Mri pelvis w/o dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28715","name":"Arthrodesis triple","description":"Arthrodesis; triple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":782.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78432","name":"Myocrd img pet 2rtracer","description":"Myocardial imaging, positron emission tomography (pet), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86807","name":"Cytotoxic antibody screening","description":"Serum screening for cytotoxic percent reactive antibody (pra); standard method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29280","name":"Strapping of hand or finger","description":"Strapping; hand or finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34707","name":"Evasc rpr ilio-iliac ndgft","description":"Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0238","name":"Oth resp proc, indiv","description":"Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4707","name":"Bicarbonate conc pow per pac","description":"Bicarbonate concentrate, powder, for hemodialysis, per packet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76872","name":"Us transrectal","description":"Ultrasound, transrectal;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37249","name":"Trluml balo angiop addl vein","description":"Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22325","name":"Treat spine fracture","description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82261","name":"Assay of biotinidase","description":"Biotinidase, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1210","name":"Lateral thoracic extension","description":"Addition to tlso, (low profile), lateral thoracic extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":162.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11047","name":"Dbrdmt bone each addl","description":"Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31200","name":"Removal of ethmoid sinus","description":"Ethmoidectomy; intranasal, anterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A8001","name":"Hard protect helmet prefab","description":"Helmet, protective, hard, prefabricated, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53275","name":"Repair of urethra defect","description":"Excision or fulguration; urethral prolapse","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95926","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46040","name":"I&d ischiorct&/perirct absc","description":"Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88400","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8631","name":"Mcp joint repl 2 pc or more","description":"Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1077.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76873","name":"Echograp trans r pros study","description":"Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27310","name":"Exploration of knee joint","description":"Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2200","name":"Limited ankle motion ea jnt","description":"Addition to lower extremity, limited ankle motion, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76805","name":"Ob us >/= 14 wks sngl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78267","name":"Urea breath tst c-14 acquisj","description":"Urea breath test, c-14 (isotopic); acquisition for analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86335","name":"Immunfix e-phorsis/urine/csf","description":"Immunofixation electrophoresis; other fluids with concentration (eg, urine, csf)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8616","name":"Coch implant microphone repl","description":"Microphone for use with cochlear implant device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57513","name":"Laser surgery of cervix","description":"Cautery of cervix; laser ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21282","name":"Lateral canthopexy","description":"Lateral canthopexy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27645","name":"Resect tibia tumor","description":"Radical resection of tumor; tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1505.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21282","name":"Lateral canthopexy","description":"Lateral canthopexy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78812","name":"Pet image skull-thigh","description":"Positron emission tomography (pet) imaging; skull base to mid-thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36555","name":"Insert non-tunnel cv cath","description":"Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65436","name":"Curette/treat cornea","description":"Removal of corneal epithelium; with application of chelating agent (eg, edta)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1035","name":"Patient transfer system <300","description":"Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88120","name":"Cytp urne 3-5 probes ea spec","description":"Cytopathology, in situ hybridization (eg, fish), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64634","name":"Destroy c/th facet jnt addl","description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); cervical or thoracic, each additional facet joint (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0507T","name":"Near ifr 2img mibmn glnd i&r","description":"Near infrared dual imaging (ie, simultaneous reflective and transilluminated light) of meibomian glands, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21183","name":"Reconstruct cranial bone","description":"Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 40 sq cm but less than 80 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62310","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12041","name":"Intmd rpr n-hf/genit 2.5cm/<","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26596","name":"Excision constricting tissue","description":"Excision of constricting ring of finger, with multiple z-plasties","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33853","name":"Rpr hypopl a-arch w/byp","description":"Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50660","name":"Removal of ureter","description":"Ureterectomy, total, ectopic ureter, combination abdominal, vaginal and/or perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27707","name":"Osteotomy fibula","description":"Osteotomy; fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":332.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90802","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86831","name":"Hla class ii phenotype qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); antibody identification by qualitative panel using complete hla phenotypes, hla class ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75994","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76818","name":"Fetal biophys profile w/nst","description":"Fetal biophysical profile; with non-stress testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0820","name":"Pwc gp 2 std port seat/back","description":"Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27098","name":"Transfer tendon to pelvis","description":"Transfer, adductor to ischium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2326","name":"Breath tube kit","description":"Power wheelchair accessory, breath tube kit for sip and puff interface","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G3003","name":"Chronic pain mgmt addl 15m","description":"Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27692","name":"Revise additional leg tendon","description":"Transfer or transplant of single tendon (with muscle redirection or rerouting); each additional tendon (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19302","name":"P-mastectomy w/ln removal","description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7010","name":"Disposable corrugated tubing","description":"Corrugated tubing, disposable, used with large volume nebulizer, 100 feet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72147","name":"Mri chest spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65870","name":"Incise inner eye adhesions","description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97533","name":"Sensory integration","description":"Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2340","name":"W/c wdth 20-23 in seat frame","description":"Power wheelchair accessory, nonstandard seat frame width, 20-23 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6690","name":"Frame typ sock interscap-tho","description":"Upper extremity addition, frame type socket, interscapular-thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22222","name":"Osteot dsc ant 1vrt sgm thrc","description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11719","name":"Trim nail(s) any number","description":"Trimming of nondystrophic nails, any number","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25300","name":"Fusion of tendons at wrist","description":"Tenodesis at wrist; flexors of fingers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92545","name":"Oscillating tracking test","description":"Oscillating tracking test, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83015","name":"Heavy metal qual any number","description":"Heavy metal (eg, antimony, arsenic, barium, beryllium, bismuth, gadolinium, mercury); qualitative, any number of analytes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87220","name":"Tissue exam for fungi","description":"Tissue examination by koh slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2087","name":"Off base opioid tx, 60 m","description":"Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92596","name":"Ear protector evaluation","description":"Ear protector attenuation measurements","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67445","name":"Explr/decompress eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); with removal of bone for decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5648","name":"Above knee cushion socket","description":"Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":363.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99421","name":"Ol dig e/m svc 5-10 min","description":"Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78018","name":"Thyroid met imaging body","description":"Thyroid carcinoma metastases imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31587","name":"Laryngoplasty cricoid split","description":"Laryngoplasty, cricoid split, without graft placement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0791","name":"Parenteral infusion pump sta","description":"Parenteral infusion pump, stationary, single or multi-channel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82355","name":"Calculus analysis qual","description":"Calculus; qualitative analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27215","name":"Treat pelvic fracture(s)","description":"Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral, for pelvic bone fracture patterns that do not disrupt the pelvic ring, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34812","name":"Opn fem art expos","description":"Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":181.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84590","name":"Assay of vitamin a","description":"Vitamin a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72080","name":"X-ray exam thoracolmb 2/> vw","description":"Radiologic examination, spine; thoracolumbar junction, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00164","name":"Anes px nose&sins bx sft tis","description":"Anesthesia for procedures on nose and accessory sinuses; biopsy, soft tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1755","name":"Legg perthes patten bottom t","description":"Legg perthes orthosis, (patten bottom type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":759.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77435","name":"Sbrt management","description":"Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21550","name":"Biopsy of neck/chest","description":"Biopsy, soft tissue of neck or thorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11772","name":"Exc pilonidal cyst comp","description":"Excision of pilonidal cyst or sinus; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43752","name":"Nasal/orogastric w/tube plmt","description":"Naso- or oro-gastric tube placement, requiring physicians skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15822","name":"Blepharoplasty upper eyelid","description":"Blepharoplasty, upper eyelid;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49320","name":"Diag laparo separate proc","description":"Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5653","name":"Knee disart expand wall sock","description":"Addition to lower extremity, knee disarticulation, expandable wall socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8465","name":"Shrinker upper limb","description":"Prosthetic shrinker, upper limb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99252","name":"Ip/obs consltj new/est sf 35","description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5707","name":"Custom shape cvr hip disart","description":"Custom shaped protective cover, hip disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98927","name":"Osteopath manj 5-6 regions","description":"Osteopathic manipulative treatment (omt); 5-6 body regions involved","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85610","name":"Prothrombin time","description":"Prothrombin time;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26756","name":"Pin finger fracture each","description":"Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32658","name":"Thoracoscopy w/sac fb remove","description":"Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":568.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26357","name":"Repair finger/hand tendon","description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no mans land); secondary, without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83020","name":"Hemoglobin electrophoresis","description":"Hemoglobin fractionation and quantitation; electrophoresis (eg, a2, s, c, and/or f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A8000","name":"Soft protect helmet prefab","description":"Helmet, protective, soft, prefabricated, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28546","name":"Treat foot dislocation","description":"Percutaneous skeletal fixation of tarsal bone dislocation, other than talotarsal, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43100","name":"Excision of esophagus lesion","description":"Excision of lesion, esophagus, with primary repair; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":487.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66988","name":"Xcapsl ctrc rmvl w/ecp","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":400.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22310","name":"Closed tx vert fx w/o manj","description":"Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50972","name":"Ureter endoscopy & catheter","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73610","name":"X-ray exam of ankle","description":"Radiologic examination, ankle; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67335","name":"Eye suture during surgery","description":"Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (list separately in addition to code for specific strabismus surgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68371","name":"Harvest eye tissue alograft","description":"Harvesting conjunctival allograft, living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54500","name":"Biopsy of testis","description":"Biopsy of testis, needle (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66682","name":"Repair iris & ciliary body","description":"Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (eg, mccannel suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":407.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75902","name":"Remove cva lumen obstruct","description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21465","name":"Optx mndblr cndylr fx","description":"Open treatment of mandibular condylar fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":665.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24160","name":"Rmvl prosthhumrl&ulnar cmpnt","description":"Removal of prosthesis, includes debridement and synovectomy when performed; humeral and ulnar components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87521","name":"Hepatitis c probe&rvrs trnsc","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis c, amplified probe technique, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6615","name":"Disconnect locking wrist uni","description":"Upper extremity addition, disconnect locking wrist unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61576","name":"Skull base/brainstem surgery","description":"Transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion; requiring splitting of tongue and/or mandible (including tracheostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25024","name":"Decompress forearm 2 spaces","description":"Decompression fasciotomy, forearm and/or wrist, flexor and extensor compartment; without debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35474","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3037.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46070","name":"Incision anal septum infant","description":"Incision, anal septum (infant)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87515","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5341","name":"Hemipelvectomy canadian sach","description":"Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33225","name":"L ventric pacing lead add-on","description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15837","name":"Exc excsv skin forearm/hand","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38700","name":"Removal of lymph nodes neck","description":"Suprahyoid lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74430","name":"Contrast x-ray bladder","description":"Cystography, minimum of 3 views, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00140","name":"Anes procedures on eye nos","description":"Anesthesia for procedures on eye; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88314","name":"Histochemical stains add-on","description":"Special stain including interpretation and report; histochemical stain on frozen tissue block (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72146","name":"Mri chest spine w/o dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88121","name":"Cytp urine 3-5 probes cmptr","description":"Cytopathology, in situ hybridization (eg, fish), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76010","name":"X-ray nose to rectum","description":"Radiologic examination from nose to rectum for foreign body, single view, child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87534","name":"Hiv-1 dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-1, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24359","name":"Repair elbow deb/attch open","description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfers elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36011","name":"Place catheter in vein","description":"Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":703.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8614","name":"Cochlear device","description":"Cochlear device, includes all internal and external components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9507.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0985","name":"W/c seat lift mechanism","description":"Wheelchair accessory, seat lift mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7035","name":"Pos airway press headgear","description":"Headgear used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"E1340","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44660","name":"Repair bowel-bladder fistula","description":"Closure of enterovesical fistula; without intestinal or bladder resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32500","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1118.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6443","name":"Conform band n/s w>=3in<5in/yd","description":"Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84446","name":"Assay of vitamin e","description":"Tocopherol alpha (vitamin e)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65140","name":"Attach ocular implant","description":"Insertion of ocular implant secondary; after enucleation, muscles attached to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84376","name":"Sugars single qual","description":"Sugars (mono-, di-, and oligosaccharides); single qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82330","name":"Assay of calcium","description":"Calcium; ionized","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26455","name":"Incision of finger tendon","description":"Tenotomy, flexor, finger, open, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15922","name":"Exc coccygl pr ulc flap clsr","description":"Excision, coccygeal pressure ulcer, with coccygectomy; with flap closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43191","name":"Esophagoscopy rigid trnso dx","description":"Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45108","name":"Anorectal myomectomy","description":"Anorectal myomectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70558","name":"Mri brain w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7045","name":"Repl exhalation port for pap","description":"Exhalation port with or without swivel used with accessories for positive airway devices, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86808","name":"Cytotoxic antibody screening","description":"Serum screening for cytotoxic percent reactive antibody (pra); quick method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59050","name":"Fetal monitor w/report","description":"Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6402","name":"Sterile gauze <= 16 sq in","description":"Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0850","name":"Traction stand free standing","description":"Traction stand, free standing, cervical traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8609","name":"Artificial cornea","description":"Artificial cornea","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26530","name":"Revise knuckle joint","description":"Arthroplasty, metacarpophalangeal joint; each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81182","name":"Atxn8os gen detc abnor allel","description":"Atxn8os (atxn8 opposite strand [non-protein coding]) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86361","name":"T cell absolute count","description":"T cells; absolute cd4 count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49606","name":"Repair umbilical lesion","description":"Repair of large omphalocele or gastroschisis; with removal of prosthesis, final reduction and closure, in operating room","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":952.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27808","name":"Treatment of ankle fracture","description":"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51865","name":"Repair of bladder wound","description":"Cystorrhaphy, suture of bladder wound, injury or rupture; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":736.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0660","name":"Pneumatic appliance full leg","description":"Non-segmental pneumatic appliance for use with pneumatic compressor, full leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7170","name":"Electronic elbow hosmer swit","description":"Electronic elbow, hosmer or equal, switch controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2909.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3967","name":"Sewho airplane w/o jnts cf","description":"Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26600","name":"Treat metacarpal fracture","description":"Closed treatment of metacarpal fracture, single; without manipulation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87153","name":"Dna/rna sequencing","description":"Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16s rrna gene)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77431","name":"Radiation therapy management","description":"Radiation therapy management with complete course of therapy consisting of 1 or 2 fractions only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71110","name":"X-ray exam ribs bil 3 views","description":"Radiologic examination, ribs, bilateral; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74240","name":"X-ray xm upr gi trc 1cntrst","description":"Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25635","name":"Cltx carpl fx w/mnpj ea b1","description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); with manipulation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2780","name":"Oversize lens/es","description":"Oversize lens, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27448","name":"Incision of thigh","description":"Osteotomy, femur, shaft or supracondylar; without fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2250","name":"Remot img sub by pt, non e/m","description":"Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or p","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89060","name":"Exam synovial fluid crystals","description":"Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29866","name":"Autgrft implnt knee w/scope","description":"Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":888.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35695","name":"Art trnsposj carotid subclav","description":"Transposition and/or reimplantation; carotid to subclavian artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":904.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63042","name":"Laminotomy single lumbar","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1142.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87279","name":"Parainfluenza ag if","description":"Infectious agent antigen detection by immunofluorescent technique; parainfluenza virus, each type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43239","name":"Egd biopsy single/multiple","description":"Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95908","name":"Nrv cndj tst 3-4 studies","description":"Nerve conduction studies; 3-4 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93567","name":"Njx car cth sprvlv aortgrphy","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0710","name":"Restraints any type","description":"Restraints, any type (body, chest, wrist or ankle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5280","name":"Hemipelvect canad sing axis","description":"Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33463","name":"Valvuloplasty tricuspid","description":"Valvuloplasty, tricuspid valve; without ring insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2676.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65210","name":"Remove foreign body from eye","description":"Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1005","name":"Tension based scoliosis orth","description":"Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51741","name":"Electro-uroflowmetry first","description":"Complex uroflowmetry (eg, calibrated electronic equipment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92070","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22843","name":"Insert spine fixation device","description":"Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":729.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23000","name":"Rmvl sbdltd clcreous dep opn","description":"Removal of subdeltoid calcareous deposits, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93981","name":"Penile vascular study","description":"Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0198T","name":"Ocular blood flow measure","description":"Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94727","name":"Gas dil/wshot deter lng vol","description":"Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1660","name":"Ho abduction static plastic","description":"Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22511","name":"Perq lumbosacral injection","description":"Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42235","name":"Repair palate","description":"Repair of anterior palate, including vomer flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33783","name":"Nikaidoh proc w/ostia implt","description":"Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, nikaidoh procedure); with reimplantation of 1 or both coronary ostia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3051.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97542","name":"Wheelchair mngment training","description":"Wheelchair management (eg, assessment, fitting, training), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6530","name":"Compression stocking bk18-30","description":"Gradient compression stocking, below knee, 18-30 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15156","name":"Tis clt agrft f/s/n/h/f/g ad","description":"Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 75 sq cm (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0502","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54408","name":"Repair multi-comp penis pros","description":"Repair of component(s) of a multi-component, inflatable penile prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":640.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30210","name":"Nasal sinus therapy","description":"Displacement therapy (proetz type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2504","name":"Sgd prerec msg>20min <=40min","description":"Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0971","name":"Wheelchair anti-tipping devi","description":"Manual wheelchair accessory, anti-tipping device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63271","name":"Excise intrspinl lesion thrc","description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1890.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8042","name":"Orbital prosthesis","description":"Orbital prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","KM","95","93","NU","","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75901","name":"Remove cva device obstruct","description":"Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33285","name":"Insj subq car rhythm mntr","description":"Insertion, subcutaneous cardiac rhythm monitor, including programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4074.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00562","name":"Anes px hrt w/pump age 1yr+","description":"Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, age 1 year or older, for all noncoronary bypass procedures (eg, valve procedures) or for re-operation for coronary bypass more than 1 month after original operation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64832","name":"Repair nerve add-on","description":"Suture of digital nerve, hand or foot; each additional digital nerve (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57556","name":"Remove cervix repair bowel","description":"Excision of cervical stump, vaginal approach; with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24800","name":"Arthrodesis elbw joint local","description":"Arthrodesis, elbow joint; local","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":701.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33401","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1226.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49501","name":"Rpr ing hernia init blocked","description":"Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6210","name":"Foam drg >16<=48 sq in w/o b","description":"Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52649","name":"Prostate laser enucleation","description":"Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27248","name":"Treat thigh fracture","description":"Open treatment of greater trochanteric fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43870","name":"Closure gastrostomy surgical","description":"Closure of gastrostomy, surgical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78315","name":"Bone imaging 3 phase","description":"Bone and/or joint imaging; 3 phase study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49446","name":"Change g-tube to g-j perc","description":"Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69645","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1177.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81178","name":"Atxn1 gene detc abnor allele","description":"Atxn1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0016","name":"Alcohol and/or drug services","description":"Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49596","name":"Rpr aa hrn 1st > 10 ncr/strn","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":816.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92650","name":"Aep scr auditory potential","description":"Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78813","name":"Pet image full body","description":"Positron emission tomography (pet) imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0110","name":"Crutch forearm pair","description":"Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94777","name":"Ped home apnea mntr rvw i&r","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; review, interpretation and preparation of report only by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33507","name":"Repair art intramural","description":"Repair of anomalous (eg, intramural) aortic origin of coronary artery by unroofing or translocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5507","name":"Modification diabetic shoe","description":"For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90834","name":"Psytx w pt 45 minutes","description":"Psychotherapy, 45 minutes with patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01966","name":"Anes induced abortion px","description":"Anesthesia for induced abortion procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A8001","name":"Hard protect helmet prefab","description":"Helmet, protective, hard, prefabricated, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55605","name":"Vesiculotomy complicated","description":"Vesiculotomy; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63741","name":"Install spinal shunt","description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29871","name":"Arthrs knee surg for infctj","description":"Arthroscopy, knee, surgical; for infection, lavage and drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":432.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24360","name":"Reconstruct elbow joint","description":"Arthroplasty, elbow; with membrane (eg, fascial)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":762.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49610","name":"Repair umbilical lesion","description":"Repair of omphalocele (gross type operation); first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":577.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35907","name":"Excision graft abdomen","description":"Excision of infected graft; abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93990","name":"Doppler flow testing","description":"Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41520","name":"Reconstruction tongue fold","description":"Frenoplasty (surgical revision of frenum, eg, with z-plasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97537","name":"Community/work reintegration","description":"Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0580","name":"Nebulizer for use w/ regulat","description":"Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95867","name":"Ndl emg cranial nrv musc uni","description":"Needle electromyography; cranial nerve supplied muscle(s), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5694","name":"Ak pelvic control belt pad/l","description":"Addition to lower extremity, above knee, pelvic control belt, padded and lined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82030","name":"Assay of adp & amp","description":"Adenosine, 5-monophosphate, cyclic (cyclic amp)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62329","name":"Ther spi pnxr csf fluor/ct","description":"Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or ct guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26542","name":"Repair hand joint with graft","description":"Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92562","name":"Loudness balance test","description":"Loudness balance test, alternate binaural or monaural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11471","name":"Exc skn h/p/p/u complex","description":"Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":335.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64632","name":"N block inj common digit","description":"Destruction by neurolytic agent; plantar common digital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37248","name":"Trluml balo angiop 1st vein","description":"Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50947","name":"Laparo new ureter/bladder","description":"Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76817","name":"Transvaginal us obstetric","description":"Ultrasound, pregnant uterus, real time with image documentation, transvaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28103","name":"Remove/graft foot lesion","description":"Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1040","name":"Lumbar or lumbar rib pad","description":"Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4562","name":"Pessary reusable nonrubber","description":"Pessary, reusable, non rubber, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86001","name":"Allergen specific igg","description":"Allergen specific igg quantitative or semiquantitative, each allergen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21070","name":"Remove coronoid process","description":"Coronoidectomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50385","name":"Change stent via transureth","description":"Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":872.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26116","name":"Exc hand tum deep < 1.5 cm","description":"Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93650","name":"Icar cath abltj av node func","description":"Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":630.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11307","name":"Shave skin lesion 1.1-2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78261","name":"Gastric mucosa imaging","description":"Gastric mucosa imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48500","name":"Surgery of pancreatic cyst","description":"Marsupialization of pancreatic cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":962.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76814","name":"Ob us nuchal meas add-on","description":"Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8440","name":"Shrinker below knee","description":"Prosthetic shrinker, below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2363","name":"Gr24 sealed leadacid battery","description":"Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1920","name":"Afo sing upright w/ adjust s","description":"Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99253","name":"Ip/obs cnsltj new/est low 45","description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21495","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":570.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66185","name":"Revise aqueous shunt eye","description":"Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0130","name":"Single energy x-ray study","description":"Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69646","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1246.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21325","name":"Open tx nose fx uncomplicatd","description":"Open treatment of nasal fracture; uncomplicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0045","name":"Ftrst compl assembly repl ea","description":"Footrest, complete assembly, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42226","name":"Lengthening of palate","description":"Lengthening of palate, and pharyngeal flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78801","name":"Rp loclzj tum 2+area 1+d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or m","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0154","name":"Walker platform attachment","description":"Platform attachment, walker, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32602","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82009","name":"Ketone bodys qual","description":"Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24500","name":"Cltx humrl shft fx w/o mnpj","description":"Closed treatment of humeral shaft fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92614","name":"Laryngoscopic sensory vid","description":"Flexible endoscopic evaluation, laryngeal sensory testing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0260","name":"Hosp bed semi-electr w/ matt","description":"Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72192","name":"Ct pelvis w/o dye","description":"Computed tomography, pelvis; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15200","name":"Fth/gft fr trnk 20 sq cm/<","description":"Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45805","name":"Repair fistula w/colostomy","description":"Closure of rectovesical fistula; with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1227.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73660","name":"X-ray exam of toe(s)","description":"Radiologic examination; toe(s), minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51590","name":"Remove bladder/revise tract","description":"Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1569.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99403","name":"Prev med cnsl indiv apprx 45","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84106","name":"Test for porphobilinogen","description":"Porphobilinogen, urine; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86886","name":"Coombs test indirect titer","description":"Antihuman globulin test (coombs test); indirect, each antibody titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21338","name":"Open nasoethmoid fx w/o fixj","description":"Open treatment of nasoethmoid fracture; without external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86641","name":"Cryptococcus antibody","description":"Antibody; cryptococcus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27090","name":"Removal of hip prosthesis","description":"Removal of hip prosthesis; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":703.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45317","name":"Proctosigmoidoscopy bleed","description":"Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6805","name":"Term dev modifier wrist unit","description":"Addition to terminal device, modifier wrist unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72069","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84578","name":"Test urine urobilinogen","description":"Urobilinogen, urine; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5061","name":"Pouch drainable w barrier at","description":"Ostomy pouch, drainable; with barrier attached, (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93235","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87527","name":"Hepatitis g dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis g, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20525","name":"Rmvl fb musc/tdn deep/comp","description":"Removal of foreign body in muscle or tendon sheath; deep or complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":390.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43216","name":"Esophagoscopy lesion removal","description":"Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16036","name":"Escharotomy ea addl incision","description":"Escharotomy; each additional incision (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73660","name":"X-ray exam of toe(s)","description":"Radiologic examination; toe(s), minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73206","name":"Ct angio upr extrm w/o&w/dye","description":"Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5678","name":"Bk joint covers pair","description":"Additions to lower extremity, below knee, joint covers, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75743","name":"Artery x-rays lungs","description":"Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61623","name":"Evasc temp balo artl occ h/n","description":"Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiogra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":505.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3961","name":"Sewho cap design w/o jnts cf","description":"Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4357","name":"Bedside drainage bag","description":"Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66183","name":"Insert ant drainage device","description":"Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":618.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20937","name":"Sp bone agrft morsel add-on","description":"Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43774","name":"Lap rmvl gastr adj all parts","description":"Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63267","name":"Excise intrspinl lesion lmbr","description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20604","name":"Drain/inj joint/bursa w/us","description":"Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95887","name":"Musc tst done w/n tst nonext","description":"Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0968","name":"Wheelchair commode seat","description":"Commode seat, wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50688","name":"Change of ureter tube/stent","description":"Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44406","name":"Colonoscopy w/ultrasound","description":"Colonoscopy through stoma; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81190","name":"Cstb gene known famil vrnt","description":"Cstb (cystatin b) (eg, unverricht-lundborg disease) gene analysis; known familial variant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82270","name":"Occult blood feces","description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5652","name":"Suction susp ak/knee disart","description":"Addition to lower extremity, suction suspension, above knee or knee disarticulation socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":216.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5681","name":"Intl custm cong/latyp insert","description":"Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0237","name":"Therapeutic procd strg endur","description":"Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78201","name":"Liver imaging static only","description":"Liver imaging; static only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21387","name":"Opn tx orbit fx combined","description":"Open treatment of orbital floor blowout fracture; combined approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":651.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33340","name":"Perq clsr tcat l atr apndge","description":"Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":684.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A6200","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27086","name":"Remove hip foreign body","description":"Removal of foreign body, pelvis or hip; subcutaneous tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78230","name":"Salivary gland imaging","description":"Salivary gland imaging;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76856","name":"Us exam pelvic complete","description":"Ultrasound, pelvic (nonobstetric), real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43860","name":"Revj gstr/jj anast w/o vgtmy","description":"Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73521","name":"X-ray exam hips bi 2 views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33660","name":"Repair of heart defects","description":"Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal defect), with or without atrioventricular valve repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92537","name":"Caloric vstblr test w/rec","description":"Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58974","name":"Embryo transfer intrauterine","description":"Embryo transfer, intrauterine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00320","name":"Anes all px neck nos 1yr/>","description":"Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35563","name":"Art byp grft ilioiliac","description":"Bypass graft, with vein; ilioiliac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1168.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4540","name":"Reusable underpad chair size","description":"Incontinence product, protective underpad, reusable, chair size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61791","name":"Treat trigeminal tract","description":"Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1023.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96164","name":"Hlth bhv ivntj grp 1st 30","description":"Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44211","name":"Lap colectomy w/proctectomy","description":"Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (s or j), with loop ileostomy, includes rectal mucosectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1648.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5112","name":"Urinary leg bag","description":"Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4730","name":"Fistula cannulation set, ea","description":"Fistula cannulation set for hemodialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52277","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with resection of external sphincter (sphincterotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01420","name":"Anes cst appl rmv/rpr kne jt","description":"Anesthesia for all cast applications, removal, or repair involving knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1039","name":"Transport chair pt wt >300lb","description":"Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49465","name":"Fluoro exam of g/colon tube","description":"Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41135","name":"Tongue and neck surgery","description":"Glossectomy; partial, with unilateral radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1683.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80414","name":"Testosterone response panel","description":"Chorionic gonadotropin stimulation panel; testosterone response this panel must include the following: testosterone (84403 x 2 on 3 pooled blood samples)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99342","name":"Home/res vst new low mdm 30","description":"Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3925","name":"Fo pip dip jnt/sprng pre ots","description":"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44111","name":"Excision of bowel lesion(s)","description":"Excision of 1 or more lesions of small or large intestine not requiring anastomosis, exteriorization, or fistulization; multiple enterotomies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47480","name":"Incision of gallbladder","description":"Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":729.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36600","name":"Withdrawal of arterial blood","description":"Arterial puncture, withdrawal of blood for diagnosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36248","name":"Ins cath abd/l-ext art addl","description":"Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88348","name":"Electron microscopy dx","description":"Electron microscopy, diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69717","name":"Rplcmt oi implt skl prq esp","description":"Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":898.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92025","name":"Cptrized corneal topography","description":"Computerized corneal topography, unilateral or bilateral, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2306","name":"Lens sphcyl trifocal 4.00/>6","description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32905","name":"Revise & repair chest wall","description":"Thoracoplasty, schede type or extrapleural (all stages);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1066.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00730","name":"Anes px upper pst abdl wall","description":"Anesthesia for procedures on upper posterior abdominal wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11641","name":"Exc f/e/e/n/l mal+mrg 0.6-1","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5971","name":"Sach foot, replacement","description":"All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24665","name":"Optx radial head/neck fx","description":"Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":548.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67030","name":"Incise inner eye strands","description":"Discission of vitreous strands (without removal), pars plana approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36425","name":"Venipuncture cutdown 1 yr/>","description":"Venipuncture, cutdown; age 1 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00926","name":"Anes male gent rad orch ing","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); radical orchiectomy, inguinal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32310","name":"Removal of chest lining","description":"Pleurectomy, parietal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70487","name":"Ct maxillofacial w/dye","description":"Computed tomography, maxillofacial area; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62225","name":"Replace/irrigate catheter","description":"Replacement or irrigation, ventricular catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54120","name":"Partial removal of penis","description":"Amputation of penis; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6550","name":"Shldr disar prosth tiss shap","description":"Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1892.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27091","name":"Removal of hip prosthesis","description":"Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94774","name":"Ped home apnea mntr evnt rec","description":"Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, review, interpretation, and preparation of a report by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82135","name":"Assay aminolevulinic acid","description":"Aminolevulinic acid, delta (ala)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3672","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":496.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96001","name":"Motion test w/ft press meas","description":"Comprehensive computer-based motion analysis by video-taping and 3d kinematics; with dynamic plantar pressure measurements during walking","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99359","name":"Prolong serv w/o contact add","description":"Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (list separately in addition to code for prolonged service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0890","name":"Traction frame attach pelvic","description":"Traction frame, attached to footboard, pelvic traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21390","name":"Opn tx orbit periorbtl implt","description":"Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":649.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49327","name":"Lap ins device for rt","description":"Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (list separately in addition to code for primary proced","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2319","name":"Lens trifocal seg width > 28","description":"Trifocal seg width over 28 mm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58561","name":"Hysteroscopy remove myoma","description":"Hysteroscopy, surgical; with removal of leiomyomata","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92612","name":"Endoscopy swallow (fees) vid","description":"Flexible endoscopic evaluation of swallowing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93272","name":"Ecg/review interpret only","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97552","name":"Group caregiver training","description":"Group caregiver training in strategies and techniques to facilitate the patients functional performance in the home or community (eg, activities of daily living [adls], instrumental adls [iadls], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28400","name":"Cltx calcaneal fx w/o mnpj","description":"Closed treatment of calcaneal fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8044","name":"Hemi-facial prosthesis","description":"Hemi-facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","KM","95","93","NU","","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83001","name":"Assay of gonadotropin (fsh)","description":"Gonadotropin; follicle stimulating hormone (fsh)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20102","name":"Expl pentrg wnd abd/flnk/bk","description":"Exploration of penetrating wound (separate procedure); abdomen/flank/back","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0509","name":"Crit care telehea consult 50","description":"Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26235","name":"Partial removal finger bone","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87537","name":"Hiv-2 dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-2, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33140","name":"Heart revascularize (tmr)","description":"Transmyocardial laser revascularization, by thoracotomy; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60512","name":"Autotransplant parathyroid","description":"Parathyroid autotransplantation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99172","name":"Ocular function screen","description":"Visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision (may include all or some screening of the determination[s] for contrast sensitivity, vision under glare)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86920","name":"Compatibility test spin","description":"Compatibility test each unit; immediate spin technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83704","name":"Lipoprotein bld quan part","description":"Lipoprotein, blood; quantitation of lipoprotein particle number(s) (eg, by nuclear magnetic resonance spectroscopy), includes lipoprotein particle subclass(es), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94669","name":"Mechanical chest wall oscill","description":"Mechanical chest wall oscillation to facilitate lung function, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86663","name":"Epstein-barr antibody","description":"Antibody; epstein-barr (eb) virus, early antigen (ea)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92608","name":"Ex for speech device rx addl","description":"Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87168","name":"Macroscopic exam arthropod","description":"Macroscopic examination; arthropod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88348","name":"Electron microscopy dx","description":"Electron microscopy, diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57400","name":"Dilation of vagina","description":"Dilation of vagina under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59821","name":"Treatment of miscarriage","description":"Treatment of missed abortion, completed surgically; second trimester","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0848","name":"Pwc gp 3 std seat/back","description":"Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19342","name":"Insj/rplcmt brst implt sep d","description":"Insertion or replacement of breast implant on separate day from mastectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":596.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43197","name":"Esophagoscopy flex dx brush","description":"Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63015","name":"Remove spine lamina >2 crvcl","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42210","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22857","name":"Tot disc arthrp 1ntrspc lmbr","description":"Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85379","name":"Fibrin degradation quant","description":"Fibrin degradation products, d-dimer; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76529","name":"Echo exam of eye","description":"Ophthalmic ultrasonic foreign body localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46946","name":"Int hrhc lig 2+hroid w/o img","description":"Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups, without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29894","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88738","name":"Hgb quant transcutaneous","description":"Hemoglobin (hgb), quantitative, transcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11201","name":"Rmvl skin tags ea addl 10","description":"Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32665","name":"Thoracoscop w/esoph musc exc","description":"Thoracoscopy, surgical; with esophagomyotomy (heller type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":985.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43324","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":978.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40812","name":"Excise/repair mouth lesion","description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00326","name":"Anes all px larynx&trach<1yr","description":"Anesthesia for all procedures on the larynx and trachea in children younger than 1 year of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41135","name":"Tongue and neck surgery","description":"Glossectomy; partial, with unilateral radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82103","name":"Alpha-1-antitrypsin total","description":"Alpha-1-antitrypsin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33018","name":"Prcrd drg 0-5yr or w/anomly","description":"Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; birth through 5 years of age or any age with congenital cardiac anomaly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47900","name":"Suture bile duct injury","description":"Suture of extrahepatic biliary duct for pre-existing injury (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1139.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27385","name":"Repair of thigh muscle","description":"Suture of quadriceps or hamstring muscle rupture; primary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":493.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47563","name":"Laparo cholecystectomy/graph","description":"Laparoscopy, surgical; cholecystectomy with cholangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":598.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23335","name":"Shoulder prosthesis removal","description":"Removal of prosthesis, includes debridement and synovectomy when performed; humeral and glenoid components (eg, total shoulder)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26185","name":"Remove finger bone","description":"Sesamoidectomy, thumb or finger (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":462.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74300","name":"X-ray bile ducts/pancreas","description":"Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35231","name":"Repair blvsl vn grf neck","description":"Repair blood vessel with vein graft; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1065.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62328","name":"Dx lmbr spi pnxr w/fluor/ct","description":"Spinal puncture, lumbar, diagnostic; with fluoroscopic or ct guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33945","name":"Transplantation of heart","description":"Heart transplant, with or without recipient cardiectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22844","name":"Insert spine fixation device","description":"Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87285","name":"Treponema pallidum ag if","description":"Infectious agent antigen detection by immunofluorescent technique; treponema pallidum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98941","name":"Chiropract manj 3-4 regions","description":"Chiropractic manipulative treatment (cmt); spinal, 3-4 regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65600","name":"Revision of cornea","description":"Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43888","name":"Gstr rstcv px opn rmvl&rplc","description":"Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7015","name":"Aerosol mask used w nebulize","description":"Aerosol mask, used with dme nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2270","name":"Varus/valgus strap padded/li","description":"Addition to lower extremity, varus/valgus correction (t) strap, padded/lined or malleolus pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24655","name":"Cltx rdl head/nck fx w/mnpj","description":"Closed treatment of radial head or neck fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":367.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54440","name":"Repair of penis","description":"Plastic operation of penis for injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41821","name":"Excision of gum flap","description":"Operculectomy, excision pericoronal tissues","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24371","name":"Revise reconst elbow joint","description":"Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21084","name":"Impres&prep sp aid prosth","description":"Impression and custom preparation; speech aid prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1282.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23625","name":"Cltx gr hmrl tbrs fx w/mnpj","description":"Closed treatment of greater humeral tuberosity fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6000","name":"Wound warming wound cover","description":"Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0761","name":"Nontherm electromgntc device","description":"Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69714","name":"Impl oi implt skull perq esp","description":"Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21554","name":"Exc neck tum deep 5 cm/>","description":"Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":623.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21497","name":"Interdental wirg oth/thn fx","description":"Interdental wiring, for condition other than fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14060","name":"Tis trnfr e/n/e/l 10 sq cm/<","description":"Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":474.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99281","name":"Emr dpt vst mayx req phy/qhp","description":"Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93236","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38205","name":"Harvest allogeneic stem cell","description":"Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67973","name":"Reconstruction of eyelid","description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35521","name":"Art byp grft axill-femoral","description":"Bypass graft, with vein; axillary-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83866","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81167","name":"Brca2 gene full dup/del alys","description":"Brca2 (brca2, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59025","name":"Fetal non-stress test","description":"Fetal non-stress test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24435","name":"Rpr non/mal hum with agrft","description":"Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00500","name":"Anes all px on esophagus","description":"Anesthesia for all procedures on esophagus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76982","name":"Use 1st target lesion","description":"Ultrasound, elastography; first target lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92614","name":"Laryngoscopic sensory vid","description":"Flexible endoscopic evaluation, laryngeal sensory testing by cine or video recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27530","name":"Treat knee fracture","description":"Closed treatment of tibial fracture, proximal (plateau); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69320","name":"Rebuild outer ear canal","description":"Reconstruction external auditory canal for congenital atresia, single stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1236.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95805","name":"Multiple sleep latency test","description":"Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82726","name":"Long chain fatty acids","description":"Very long chain fatty acids","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39540","name":"Repair of diaphragm hernia","description":"Repair, diaphragmatic hernia (other than neonatal), traumatic; acute","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11403","name":"Exc tr-ext b9+marg 2.1-3cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58120","name":"Dilation and curettage","description":"Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93278","name":"Ecg/signal-averaged","description":"Signal-averaged electrocardiography (saecg), with or without ecg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4235","name":"Lithium batt for glucose mon","description":"Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","KL","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53442","name":"Remove/revise male sling","description":"Removal or revision of sling for male urinary incontinence (eg, fascia or synthetic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":634.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92523","name":"Speech sound lang comprehen","description":"Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35661","name":"Bpg femoral-femoral","description":"Bypass graft, with other than vein; femoral-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":953.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99234","name":"Hosp ip/obs sm dt sf/low 45","description":"Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. when using total time on the date ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92924","name":"Prq trluml c athrc 1 art&/br","description":"Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed, single major coronary artery and/or its branch(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82331","name":"Calcium infusion test","description":"Calcium; after calcium infusion test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00520","name":"Anes closed chest px nos","description":"Anesthesia for closed chest procedures; (including bronchoscopy) not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22856","name":"Tot disc arthrp 1ntrspc crv","description":"Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1456.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0371","name":"Nonpower mattress overlay","description":"Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93000","name":"Electrocardiogram complete","description":"Electrocardiogram, routine ecg with at least 12 leads; with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62291","name":"Njx px discography crv/thrc","description":"Injection procedure for discography, each level; cervical or thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71271","name":"Ct thorax lung cancer scr c-","description":"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45333","name":"Sigmoidoscopy & polypectomy","description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":242.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65775","name":"Correction of astigmatism","description":"Corneal wedge resection for correction of surgically induced astigmatism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12006","name":"Rpr s/n/a/gen/trk20.1-30.0cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62369","name":"Anal sp inf pmp w/reprg&fill","description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31546","name":"Remove vc lesion scope/graft","description":"Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35302","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; superficial femoral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95144","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single dose vial(s) (specify number of vials)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4402","name":"Lubricant per ounce","description":"Lubricant, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7044","name":"Pap oral interface","description":"Oral interface used with positive airway pressure device, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63270","name":"Excise intrspinl lesion crvl","description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4394","name":"Ostomy pouch liq deodorant","description":"Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50572","name":"Kidney endoscopy","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19307","name":"Mast mod rad","description":"Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95886","name":"Musc test done w/n test comp","description":"Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (list separately in addition to code for ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4311","name":"Catheter w/o bag 2-way latex","description":"Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70491","name":"Ct soft tissue neck w/dye","description":"Computed tomography, soft tissue neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70545","name":"Mr angiography head w/dye","description":"Magnetic resonance angiography, head; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86711","name":"John cunningham antibody","description":"Antibody; jc (john cunningham) virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51060","name":"Removal of ureter stone","description":"Transvesical ureterolithotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92544","name":"Optokinetic nystagmus test","description":"Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2341","name":"W/c wdth 24-27 in seat frame","description":"Power wheelchair accessory, nonstandard seat frame width, 24-27 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0202U","name":"Nfct ds 22 trgt sars-cov-2","description":"Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (dna or rna), 22 targets including severe acute respiratory syndrome coronavirus 2 (sars-cov-2), qualitative rt-pcr, nasopharyngeal swab, each pathogen reported as detected or not detected","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33361","name":"Replace aortic valve perq","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; percutaneous femoral artery approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65710","name":"Corneal transplant","description":"Keratoplasty (corneal transplant); anterior lamellar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":676.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12034","name":"Intmd rpr s/tr/ext 7.6-12.5","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99217","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55150","name":"Removal of scrotum","description":"Resection of scrotum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95783","name":"Polysom <6 yrs cpap/bilvl","description":"Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":650.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15335","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99245","name":"Off/op consltj new/est hi 55","description":"Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63200","name":"Release spinal cord lumbar","description":"Laminectomy, with release of tethered spinal cord, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12034","name":"Intmd rpr s/tr/ext 7.6-12.5","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1230","name":"Milwaukee type superstructur","description":"Addition to tlso, (low profile), milwaukee type superstructure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":353.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84630","name":"Assay of zinc","description":"Zinc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63048","name":"Lam facetec &foramot ea addl","description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional vertebral segment, cervical, thoracic, or lumbar (list separately in addition t","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6549","name":"Grad com garm noc day use","description":"Gradient compression garment, not otherwise specified, for daytime use, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90935","name":"Hemodialysis one evaluation","description":"Hemodialysis procedure with single evaluation by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86356","name":"Mononuclear cell antigen","description":"Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2530","name":"Thigh/wght bear lacer non-mo","description":"Addition to lower extremity, thigh-weight bearing, lacer, non-molded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83030","name":"Hemoglobin f fetal chemical","description":"Hemoglobin; f (fetal), chemical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51980","name":"Construct bladder opening","description":"Cutaneous vesicostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49520","name":"Rerepair ing hernia reduce","description":"Repair recurrent inguinal hernia, any age; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70551","name":"Mri brain stem w/o dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97028","name":"Ultraviolet therapy","description":"Application of a modality to 1 or more areas; ultraviolet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0562","name":"Humidifier heated used w pap","description":"Humidifier, heated, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0471","name":"Rad w/backup non inv intrfc","description":"Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43865","name":"Revj gstr/jj anast w/vgtmy","description":"Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; with vagotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1436.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2621","name":"Wc planar back cush wd>=22in","description":"Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58960","name":"Exploration of abdomen","description":"Laparotomy, for staging or restaging of ovarian, tubal, or primary peritoneal malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aortic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70130","name":"X-ray exam of mastoids","description":"Radiologic examination, mastoids; complete, minimum of 3 views per side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49594","name":"Rpr aa hrn 1st 3-10 ncr/strn","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":598.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21451","name":"Cltx mndblr fx w/mnpj","description":"Closed treatment of mandibular fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4620","name":"Variable concentration mask","description":"Variable concentration mask","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99606","name":"Mtms by pharm est 15 min","description":"Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, established patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33782","name":"Nikaidoh proc","description":"Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, nikaidoh procedure); without coronary ostium reimplantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64425","name":"Njx aa&/strd ii ih nerves","description":"Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal, iliohypogastric nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31294","name":"Nsl/sins ndsc surg on dcmprn","description":"Nasal/sinus endoscopy, surgical, with optic nerve decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15241","name":"Fth/gft f/c/c/m/n/a/g/h/f ea","description":"Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29884","name":"Arthrs knee surg lysis ads","description":"Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":521.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62380","name":"Ndsc dcmprn 1 ntrspc lumbar","description":"Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27151","name":"Incision of hip bones","description":"Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1346.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83916","name":"Oligoclonal bands","description":"Oligoclonal immune (oligoclonal bands)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53600","name":"Dilate urethra stricture","description":"Dilation of urethral stricture by passage of sound or urethral dilator, male; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4168","name":"Parenteral sol amino acid 3.","description":"Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73130","name":"X-ray exam of hand","description":"Radiologic examination, hand; minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77408","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63082","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82642","name":"Dihydrotestosterone","description":"Dihydrotestosterone (dht)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5646","name":"Below knee cushion socket","description":"Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11010","name":"Debride skin at fx site","description":"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissues","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":299.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9486","name":"Remote e/m est. pt 10mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward med","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27440","name":"Revision of knee joint","description":"Arthroplasty, knee, tibial plateau;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":674.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5520","name":"Perp bk ptb thermopls direct","description":"Preparatory, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":872.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39520","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":750.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64447","name":"Njx aa&/strd femoral nrv img","description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22851","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35606","name":"Bpg carotid-subclavian","description":"Bypass graft, with other than vein; carotid-subclavian","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3730","name":"Forearm/arm cuffs ext/flex a","description":"Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11308","name":"Shave skin lesion >2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38101","name":"Removal of spleen partial","description":"Splenectomy; partial (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":787.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88263","name":"Chromosome analysis 45","description":"Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01630","name":"Anes opn/arthr px sho jt nos","description":"Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15750","name":"Neurovascular pedicle flap","description":"Flap; neurovascular pedicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27625","name":"Remove ankle joint lining","description":"Arthrotomy, with synovectomy, ankle;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1980","name":"Afo sing solid stirrup calf","description":"Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar bk orthosis), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7521","name":"Trach/laryn tube cuffed","description":"Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92065","name":"Orthop traing pfrmd phys/qhp","description":"Orthoptic training; performed by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98968","name":"Ph1 assmt&mgmt nqhp 21-30","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78012","name":"Thyroid uptake measurement","description":"Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28011","name":"Incision of toe tendons","description":"Tenotomy, percutaneous, toe; multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0005","name":"Ultralightweight wheelchair","description":"Ultralightweight wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0570T","name":"Ttvr perq ea addl prosth","description":"Transcatheter tricuspid valve repair, percutaneous approach; each additional prosthesis during same session (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29880","name":"Arthrs kne srg mnisectmy m&l","description":"Arthroscopy, knee, surgical; with meniscectomy (medial and lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46707","name":"Repair anorectal fist w/plug","description":"Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [sis])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96417","name":"Chemo iv infus each addl seq","description":"Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36815","name":"Insertion of cannula","description":"Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external revision, or closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92920","name":"Prq trluml c angiop 1art&/br","description":"Percutaneous transluminal coronary angioplasty, single major coronary artery and/or its branch(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":425.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20936","name":"Sp bone agrft local add-on","description":"Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B9006","name":"Parenteral infus pump statio","description":"Parenteral nutrition infusion pump, stationary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46285","name":"Remove anal fist 2 stage","description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":432.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27446","name":"Revision of knee joint","description":"Arthroplasty, knee, condyle and plateau; medial or lateral compartment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":981.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0296","name":"Visit to determ ldct elig","description":"Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54322","name":"Reconstruction of urethra","description":"1-stage distal hypospadias repair (with or without chordee or circumcision); with simple meatal advancement (eg, magpi, v-flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99243","name":"Off/op cnsltj new/est low 30","description":"Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15130","name":"Drm agrft t/a/l 1st 100 sqcm","description":"Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":457.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55842","name":"Extensive prostate surgery","description":"Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy(s) (limited pelvic lymphadenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24164","name":"Removal prosth radial head","description":"Removal of prosthesis, includes debridement and synovectomy when performed; radial head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":605.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61630","name":"Balo angioplasty icr perq","description":"Balloon angioplasty, intracranial (eg, atherosclerotic stenosis), percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1205.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31294","name":"Nsl/sins ndsc surg on dcmprn","description":"Nasal/sinus endoscopy, surgical, with optic nerve decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":922.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61690","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; dural, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87912","name":"Nfct agt gntyp alys hep b","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); hepatitis b virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01924","name":"Anes ther ivntl rad artl nos","description":"Anesthesia for therapeutic interventional radiological procedures involving the arterial system; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46761","name":"Repair of anal sphincter","description":"Sphincteroplasty, anal, for incontinence, adult; levator muscle imbrication (park posterior anal repair)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31528","name":"Laryngoscopy and dilation","description":"Laryngoscopy direct, with or without tracheoscopy; with dilation, initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0974","name":"Tlso full corset","description":"Tlso, full corset","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0720","name":"Tens two lead","description":"Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":196.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8420","name":"Prosthetic sock multi ply bk","description":"Prosthetic sock, multiple ply, below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01474","name":"Anes gastrocnemius recession","description":"Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, strayer procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42182","name":"Repair palate","description":"Repair, laceration of palate; over 2 cm or complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93981","name":"Penile vascular study","description":"Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38210","name":"T-cell depletion of harvest","description":"Transplant preparation of hematopoietic progenitor cells; specific cell depletion within harvest, t-cell depletion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43255","name":"Egd control bleeding any","description":"Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30906","name":"Repeat control of nosebleed","description":"Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20808","name":"Replantation hand complete","description":"Replantation, hand (includes hand through metacarpophalangeal joints), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32960","name":"Therapeutic pneumothorax","description":"Pneumothorax, therapeutic, intrapleural injection of air","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70498","name":"Ct angiography neck","description":"Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88377","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2500","name":"Contact lens pmma spherical","description":"Contact lens, pmma, spherical, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87328","name":"Cryptosporidium ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; cryptosporidium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4633","name":"Uvl replacement bulb","description":"Replacement bulb/lamp for ultraviolet light therapy system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1686","name":"Ho post-op hip abduction","description":"Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00834","name":"Anes hernia repair<1 yr age","description":"Anesthesia for hernia repairs in the lower abdomen not otherwise specified, younger than 1 year of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87591","name":"N.gonorrhoeae dna amp prob","description":"Infectious agent detection by nucleic acid (dna or rna); neisseria gonorrhoeae, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1950","name":"Afo spiral molded to pt plas","description":"Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0223","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0187","name":"Water pressure mattress","description":"Water pressure mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4235","name":"Lithium batt for glucose mon","description":"Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33851","name":"Exc coa rpr l subcl art/prst","description":"Excision of coarctation of aorta, with or without associated patent ductus arteriosus; repair using either left subclavian artery or prosthetic material as gusset for enlargement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1102.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94725","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42953","name":"Repair throat esophagus","description":"Pharyngoesophageal repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49205","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1426.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99463","name":"Same day nb discharge","description":"Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20553","name":"Njx 1/mlt trigger points 3/>","description":"Injection(s); single or multiple trigger point(s), 3 or more muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2611","name":"Gen use back cush wdth <22in","description":"General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36640","name":"Insertion catheter artery","description":"Arterial catheterization for prolonged infusion therapy (chemotherapy), cutdown","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74250","name":"X-ray xm sm int 1cntrst std","description":"Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70190","name":"X-ray exam of eye sockets","description":"Radiologic examination; optic foramina","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6236","name":"Hydrocolld drg > 48 in w/o b","description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87635","name":"Sars-cov-2 covid-19 amp prb","description":"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63621","name":"Srs spinal lesion addl","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28112","name":"Part removal of metatarsal","description":"Ostectomy, complete excision; other metatarsal head (second, third or fourth)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":396.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43502","name":"Surgical repair of stomach","description":"Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg, mallory-weiss)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69150","name":"Extensive ear canal surgery","description":"Radical excision external auditory canal lesion; without neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":835.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22867","name":"Insj stablj dev w/dcmprn","description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64611","name":"Chemodenerv saliv glands","description":"Chemodenervation of parotid and submandibular salivary glands, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49465","name":"Fluoro exam of g/colon tube","description":"Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70543","name":"Mri orbt/fac/nck w/o &w/dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68540","name":"Remove tear gland lesion","description":"Excision of lacrimal gland tumor; frontal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63197","name":"Lam w/cordotomy 1stg thrc","description":"Laminectomy with cordotomy, with section of both spinothalamic tracts, 1 stage, thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67902","name":"Repair eyelid defect","description":"Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":436.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64644","name":"Chemodenerv 1 extrem 5/> mus","description":"Chemodenervation of one extremity; 5 or more muscles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2202","name":"Lens sphere bifocal 7.12-20.","description":"Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43206","name":"Esoph optical endomicroscopy","description":"Esophagoscopy, flexible, transoral; with optical endomicroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21346","name":"Opn tx nasomax fx w/fixj","description":"Open treatment of nasomaxillary complex fracture (lefort ii type); with wiring and/or local fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":779.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24125","name":"Exc/crtg b1 cst/tum rds agrf","description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90460","name":"Im admin 1st/only component","description":"Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4209","name":"5+ cc sterile syringe&needle","description":"Syringe with needle, sterile 5 cc or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22850","name":"Remove spine fixation device","description":"Removal of posterior nonsegmental instrumentation (eg, harrington rod)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":638.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0373","name":"Nonpowered pressure mattress","description":"Nonpowered advanced pressure reducing mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81001","name":"Urinalysis auto w/scope","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","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82373","name":"Assay c-d transfer measure","description":"Carbohydrate deficient transferrin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0446T","name":"Insj impltbl glucose sensor","description":"Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2375","name":"Torsion ank & half solid sti","description":"Addition to lower extremity, torsion control, ankle joint and half solid stirrup","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54650","name":"Orchiopexy (fowler-stephens)","description":"Orchiopexy, abdominal approach, for intra-abdominal testis (eg, fowler-stephens)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6642","name":"Excursion amplifier lever ty","description":"Upper extremity addition, excursion amplifier, lever type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92516","name":"Facial nerve function test","description":"Facial nerve function studies (eg, electroneuronography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4604","name":"Tubing with heating element","description":"Tubing with integrated heating element for use with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86804","name":"Hep c ab test confirm","description":"Hepatitis c antibody; confirmatory test (eg, immunoblot)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2343","name":"W/c dpth 22-25 in seat frame","description":"Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0856","name":"Cervic collar w air bladders","description":"Cervical traction device, with inflatable air bladder(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16035","name":"Escharotomy 1st incision","description":"Escharotomy; initial incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86750","name":"Malaria antibody","description":"Antibody; plasmodium (malaria)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83840","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27871","name":"Fusion of tibiofibular joint","description":"Arthrodesis, tibiofibular joint, proximal or distal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92202","name":"Opscpy extnd on/mac draw","description":"Ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63044","name":"Laminotomy addl lumbar","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":214.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21014","name":"Exc face tum deep 2 cm/>","description":"Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); 2 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":435.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72158","name":"Mri lumbar spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90461","name":"Im admin each addl component","description":"Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50544","name":"Laparoscopy pyeloplasty","description":"Laparoscopy, surgical; pyeloplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1007.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24362","name":"Reconstruct elbow joint","description":"Arthroplasty, elbow; with implant and fascia lata ligament reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":897.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26852","name":"Fusion of knuckle with graft","description":"Arthrodesis, metacarpophalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":670.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65135","name":"Insert ocular implant","description":"Insertion of ocular implant secondary; after enucleation, muscles not attached to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35571","name":"Art byp pop-tibl-prl-other","description":"Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77761","name":"Apply intrcav radiat simple","description":"Intracavitary radiation source application; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77520","name":"Proton trmt simple w/o comp","description":"Proton treatment delivery; simple, without compensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78701","name":"Kidney imaging with flow","description":"Kidney imaging morphology; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01232","name":"Anes opn px upr 2/3 fem amp","description":"Anesthesia for open procedures involving upper two-thirds of femur; amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64530","name":"N block inj celiac pelus","description":"Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28288","name":"Partial removal of foot bone","description":"Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":494.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84560","name":"Assay of urine/uric acid","description":"Uric acid; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77778","name":"Apply interstit radiat compl","description":"Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":677.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45303","name":"Proctosigmoidoscopy dilate","description":"Proctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire, bougie)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87270","name":"Chlamydia trachomatis ag if","description":"Infectious agent antigen detection by immunofluorescent technique; chlamydia trachomatis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34712","name":"Tcat dlvr enhncd fixj dev","description":"Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15770","name":"Derma-fat-fascia graft","description":"Graft; derma-fat-fascia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92572","name":"Staggered spondaic word test","description":"Staggered spondaic word test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0437T","name":"Impltj synth rnfcmt abdl wal","description":"Implantation of non-biologic or synthetic implant (eg, polypropylene) for fascial reinforcement of the abdominal wall (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19287","name":"Perq dev breast 1st mr guide","description":"Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42800","name":"Biopsy of throat","description":"Biopsy; oropharynx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55801","name":"Removal of prostate","description":"Prostatectomy, perineal, subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":886.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0481","name":"Intrpulmnry percuss vent sys","description":"Intrapulmonary percussive ventilation system and related accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0483T","name":"Tmvi percutaneous approach","description":"Transcatheter mitral valve implantation/replacement (tmvi) with prosthetic valve; percutaneous approach, including transseptal puncture, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1193.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76983","name":"Use ea addl target lesion","description":"Ultrasound, elastography; each additional target lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21620","name":"Ostectomy sternum partial","description":"Ostectomy of sternum, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":432.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4617","name":"Mouth piece","description":"Mouth piece","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55810","name":"Extensive prostate surgery","description":"Prostatectomy, perineal radical;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1061.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3040","name":"Ft arch suprt premold longit","description":"Foot, arch support, removable, premolded, longitudinal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0606","name":"Aed garment w elec analysis","description":"Automatic external defibrillator, with integrated electrocardiogram analysis, garment type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2410","name":"Lens variab asphericity sing","description":"Variable asphericity lens, single vision, full field, glass or plastic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25312","name":"Transplant forearm tendon","description":"Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4162","name":"Ef ped specmetabolic inherit","description":"Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2111","name":"Spherocylindr 7.25d/.25-2.25","description":"Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5220","name":"No knee joint with artic ali","description":"Above knee, short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75600","name":"Contrast exam thoracic aorta","description":"Aortography, thoracic, without serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99252","name":"Ip/obs consltj new/est sf 35","description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85705","name":"Thromboplastin inhibition","description":"Thromboplastin inhibition, tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31205","name":"Removal of ethmoid sinus","description":"Ethmoidectomy; extranasal, total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":677.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25924","name":"Amputation follow-up surgery","description":"Disarticulation through wrist; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54111","name":"Treat penis lesion graft","description":"Excision of penile plaque (peyronie disease); with graft to 5 cm in length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76801","name":"Ob us < 14 wks single fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87531","name":"Hhv-6 dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); herpes virus-6, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0011","name":"Stnd wt pwr whlchr w control","description":"Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21355","name":"Perq tx malar fracture","description":"Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93295","name":"Dev interrog remote 1/2/mlt","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0815","name":"Pwc gp 1 std seat/back","description":"Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00632","name":"Anes px lumbar sympathectomy","description":"Anesthesia for procedures in lumbar region; lumbar sympathectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47562","name":"Laparoscopic cholecystectomy","description":"Laparoscopy, surgical; cholecystectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":549.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27705","name":"Osteotomy tibia","description":"Osteotomy; tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42826","name":"Removal of tonsils","description":"Tonsillectomy, primary or secondary; age 12 or over","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83540","name":"Assay of iron","description":"Iron","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8424","name":"Ready gradient sleeve","description":"Gradient pressure aid (sleeve), ready made","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56630","name":"Vulvectomy radical partial","description":"Vulvectomy, radical, partial;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":599.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31638","name":"Bronchoscopy revise stent","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as required)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4368","name":"Ostomy filter","description":"Ostomy filter, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73551","name":"X-ray exam of femur 1","description":"Radiologic examination, femur; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81002","name":"Urinalysis nonauto w/o scope","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","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27386","name":"Repair/graft of thigh muscle","description":"Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86060","name":"Antistreptolysin o titer","description":"Antistreptolysin 0; titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92941","name":"Prq trlml revsc tot occl ami","description":"Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single major coronary artery and/or its branches or single bypass g","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4206","name":"1 cc sterile syringe&needle","description":"Syringe with needle, sterile, 1 cc or less, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28295","name":"Cor hlx vlgs prx mtar osteot","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal metatarsal osteotomy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66740","name":"Destruction ciliary body","description":"Ciliary body destruction; cyclodialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0868","name":"Pwc gp 4 std seat/back","description":"Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01758","name":"Anes opn/arthrs elbw exc cst","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; excision of cyst or tumor of humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30420","name":"Reconstruction of nose","description":"Rhinoplasty, primary; including major septal repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1060.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3010","name":"Foot longitudinal arch suppo","description":"Foot, insert, removable, molded to patient model, longitudinal arch support, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70370","name":"Throat x-ray & fluoroscopy","description":"Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0472","name":"Tlso rigid frame hyperex pre","description":"Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76098","name":"X-ray exam surgical specimen","description":"Radiological examination, surgical specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27590","name":"Amputate leg at thigh","description":"Amputation, thigh, through femur, any level;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96127","name":"Brief emotional/behav assmt","description":"Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [adhd] scale), with scoring and documentation, per standardized instrument","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93261","name":"Interrogate subq defib","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87332","name":"Cytomegalovirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; cytomegalovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7007","name":"Adult electric hand","description":"Electric hand, switch or myoelectric controlled, adult","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1945.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77046","name":"Mri breast c- unilateral","description":"Magnetic resonance imaging, breast, without contrast material; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":193.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63055","name":"Decompress spinal cord thrc","description":"Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27267","name":"Cltx thigh fx","description":"Closed treatment of femoral fracture, proximal end, head; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":366.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28002","name":"Treatment of foot infection","description":"Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90817","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1800","name":"Adjust elbow ext & flex dev","description":"Dynamic adjustable elbow extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59855","name":"Induced abortion 1+vag supp","description":"Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":373.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0629","name":"Seat lift mech, non-electric","description":"Seat lift mechanism, non-electric, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2350","name":"Prosthetic type socket molde","description":"Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for ptb afo orthoses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27818","name":"Treatment of ankle fracture","description":"Closed treatment of trimalleolar ankle fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85390","name":"Fibrinolysins screen i&r","description":"Fibrinolysins or coagulopathy screen, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6695","name":"Elbow socket ins use w/o lck","description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27437","name":"Revise kneecap","description":"Arthroplasty, patella; without prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88334","name":"Path consltj surg cyto xm ea","description":"Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82710","name":"Fats/lipids feces quant","description":"Fat or lipids, feces; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27043","name":"Exc hip pelvis les sc 3 cm/>","description":"Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":403.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22521","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1770.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63265","name":"Excise intraspinl lesion crv","description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5585","name":"Prep ak ischial open end","description":"Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1269.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28045","name":"Exc foot/toe tum deep <1.5cm","description":"Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); less than 1.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43760","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":378.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95012","name":"Nitric oxide exp gas deter","description":"Nitric oxide expired gas determination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01999","name":"Unlisted anes procedure","description":"Unlisted anesthesia procedure(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50800","name":"Implant ureter in bowel","description":"Ureteroenterostomy, direct anastomosis of ureter to intestine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":753.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7185","name":"Electron elbow adolescent sw","description":"Electronic elbow, adolescent, variety village or equal, switch controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27059","name":"Resect hip/pelv tum 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of pelvis and hip area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1538.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78473","name":"Gated heart multiple","description":"Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11601","name":"Exc tr-ext mal+marg 0.6-1 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27134","name":"Revise hip joint replacement","description":"Revision of total hip arthroplasty; both components, with or without autograft or allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1625.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84238","name":"Assay nonendocrine receptor","description":"Receptor assay; non-endocrine (specify receptor)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0275T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1659.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5858","name":"Stance phase only","description":"Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35481","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":419.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87265","name":"Pertussis ag if","description":"Infectious agent antigen detection by immunofluorescent technique; bordetella pertussis/parapertussis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74329","name":"X-ray for pancreas endoscopy","description":"Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5102","name":"Bedside drain btl w/wo tube","description":"Bedside drainage bottle with or without tubing, rigid or expandable, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97550","name":"Caregiver traing 1st 30 min","description":"Caregiver training in strategies and techniques to facilitate the patients functional performance in the home or community (eg, activities of daily living [adls], instrumental adls [iadls], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63200","name":"Release spinal cord lumbar","description":"Laminectomy, with release of tethered spinal cord, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1388.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88261","name":"Chromosome analysis 5","description":"Chromosome analysis; count 5 cells, 1 karyotype, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0200","name":"Heat lamp without stand","description":"Heat lamp, without stand (table model), includes bulb, or infrared element","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2212","name":"Pneumatic prop tire tube","description":"Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64886","name":"Nerve graft head/neck >4 cm","description":"Nerve graft (includes obtaining graft), head or neck; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1048.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86355","name":"B cells total count","description":"B cells, total count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77021","name":"Mri guidance ndl plmt rs&i","description":"Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":369.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54060","name":"Excision of penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88125","name":"Forensic cytopathology","description":"Cytopathology, forensic (eg, sperm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62281","name":"Treat spinal cord lesion","description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":191.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71270","name":"Ct thorax dx c-/c+","description":"Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0112","name":"Crutch underarm pair wood","description":"Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64415","name":"Njx aa&/strd brch plxs img","description":"Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44382","name":"Small bowel endoscopy","description":"Ileoscopy, through stoma; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74327","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61886","name":"Implant neurostim arrays","description":"Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82656","name":"El-1 fecal qual/semiq","description":"Elastase, pancreatic (el-1), fecal; qualitative or semi-quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19001","name":"Puncture aspir cyst brst ea","description":"Puncture aspiration of cyst of breast; each additional cyst (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76812","name":"Ob us detailed addl fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28740","name":"Fusion of foot bones","description":"Arthrodesis, midtarsal or tarsometatarsal, single joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":687.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42260","name":"Repair nose to lip fistula","description":"Repair of nasolabial fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":645.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49611","name":"Repair umbilical lesion","description":"Repair of omphalocele (gross type operation); second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78202","name":"Liver imaging with vasc flow","description":"Liver imaging; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96573","name":"Pdt dstr prmlg les phys/qhp","description":"Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49040","name":"Drain open abdom abscess","description":"Drainage of subdiaphragmatic or subphrenic abscess, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":830.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33258","name":"Ablate atria x10sv add-on","description":"Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), without cardiopulmonary bypass (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":561.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92569","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93986","name":"Dup-scan hemo compl uni std","description":"Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00452","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80152","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86063","name":"Antistreptolysin o screen","description":"Antistreptolysin 0; screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31627","name":"Navigational bronchoscopy","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (list separately in addition to code for primary procedure[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99383","name":"Prev visit new age 5-11","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84431","name":"Thromboxane urine","description":"Thromboxane metabolite(s), including thromboxane if performed, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0200","name":"Cerv col supp adj bar & thor","description":"Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6540","name":"Gc stocking waistlngth 30-40","description":"Gradient compression stocking, waist length, 30-40 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4301","name":"Implantable access syst perc","description":"Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47540","name":"Perq plmt bile duct stent","description":"Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; new access,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0343","name":"Laparotomy islet cell transp","description":"Laparotomy for islet cell transplant, includes portal vein catheterization and infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58267","name":"Vag hyst w/urinary repair","description":"Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (marshall-marchetti-krantz type, pereyra type) with or without endoscopic control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94726","name":"Plethysmography lung volumes","description":"Plethysmography for determination of lung volumes and, when performed, airway resistance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28153","name":"Partial removal of toe","description":"Resection, condyle(s), distal end of phalanx, each toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27514","name":"Treatment of thigh fracture","description":"Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70549","name":"Mr angiograph neck w/o&w/dye","description":"Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0446","name":"Intens behave ther cardio dx","description":"Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65810","name":"Drainage of eye","description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25101","name":"Explore/treat wrist joint","description":"Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6403","name":"Sterile gauze>16 <= 48 sq in","description":"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0459","name":"Chest wrap","description":"Chest wrap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84119","name":"Test urine for porphyrins","description":"Porphyrins, urine; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1295","name":"Wheelchair heavy duty fixed","description":"Heavy duty wheelchair, fixed full length arms, elevating legrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33233","name":"Removal of pm generator","description":"Removal of permanent pacemaker pulse generator only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87493","name":"C diff amplified probe","description":"Infectious agent detection by nucleic acid (dna or rna); clostridium difficile, toxin gene(s), amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41252","name":"Repair tongue laceration","description":"Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87164","name":"Dark field exam spec collj","description":"Dark field examination, any source (eg, penile, vaginal, oral, skin); includes specimen collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25280","name":"Revise wrist/forearm tendon","description":"Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59300","name":"Episiotomy or vaginal repair","description":"Episiotomy or vaginal repair, by other than attending","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":183.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0858","name":"Pwc gp3 hd sing pow opt s/b","description":"Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24530","name":"Cltx sprcndylr humeral fx wo","description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0655","name":"Pneumatic appliance half arm","description":"Non-segmental pneumatic appliance for use with pneumatic compressor, half arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7004","name":"Disposable nebulizer sml vol","description":"Small volume nonfiltered pneumatic nebulizer, disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7190","name":"Elbow adolescent myoelectron","description":"Electronic elbow, adolescent, variety village or equal, myoelectronically controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4997.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74280","name":"X-ray xm colon 2cntrst std","description":"Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high density barium and air) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0136","name":"Adm of pa/n assess 5-15 m","description":"Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32504","name":"Resect apical lung tum/chest","description":"Resection of apical lung tumor (eg, pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; with chest wall reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73220","name":"Mri uppr extremity w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87107","name":"Fungi identification mold","description":"Culture, fungi, definitive identification, each organism; mold","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99341","name":"Home/res vst new sf mdm 15","description":"Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32851","name":"Lung transplant single","description":"Lung transplant, single; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2632.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42720","name":"I&d absc phrngl ntraorl appr","description":"Incision and drainage abscess; retropharyngeal or parapharyngeal, intraoral approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57292","name":"Construct vagina with graft","description":"Construction of artificial vagina; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35645","name":"Bpg subclavian-vertebral","description":"Bypass graft, with other than vein; subclavian-vertebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72202","name":"X-ray exam si joints 3/> vws","description":"Radiologic examination, sacroiliac joints; 3 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2007","name":"Post-d/c h vst ext pt 30 m","description":"Limited (30 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient faci","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31528","name":"Laryngoscopy and dilation","description":"Laryngoscopy direct, with or without tracheoscopy; with dilation, initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6448","name":"Lt compres band <3in/yd","description":"Light compression bandage, elastic, knitted/woven, width less than three inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54240","name":"Penile plethysmography","description":"Penile plethysmography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0143","name":"Walker folding wheeled w/o s","description":"Walker, folding, wheeled, adjustable or fixed height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84150","name":"Assay of prostaglandin","description":"Prostaglandin, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44025","name":"Incision of large bowel","description":"Colotomy, for exploration, biopsy(s), or foreign body removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0784","name":"Ext amb infusn pump insulin","description":"External ambulatory infusion pump, insulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86870","name":"Rbc antibody identification","description":"Antibody identification, rbc antibodies, each panel for each serum technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87327","name":"Cryptococcus neoform ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; cryptococcus neoformans","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65757","name":"Prep corneal endo allograft","description":"Backbench preparation of corneal endothelial allograft prior to transplantation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25116","name":"Remove wrist/forearm lesion","description":"Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75572","name":"Ct hrt w/3d image","description":"Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3d image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76831","name":"Echo exam uterus","description":"Saline infusion sonohysterography (sis), including color flow doppler, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69222","name":"Clean out mastoid cavity","description":"Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78103","name":"Bone marrow imaging mult","description":"Bone marrow imaging; multiple areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6881","name":"Term dev auto grasp feature","description":"Automatic grasp feature, addition to upper limb electric prosthetic terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2221","name":"Lenticular lens, bifocal","description":"Lenticular lens, per lens, bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6532","name":"Compress stking bk40-50 surg","description":"Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["AW","GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49555","name":"Rerepair fem hernia reduce","description":"Repair recurrent femoral hernia; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":501.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36572","name":"Insj picc rs&i <5 yr","description":"Insertion of peripherally inserted central venous catheter (picc), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93320","name":"Doppler echo complete","description":"Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75676","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":257.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99156","name":"Mod sed oth phys/qhp 5/>yrs","description":"Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 year","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69145","name":"Remove ear canal lesion(s)","description":"Excision soft tissue lesion, external auditory canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5100","name":"Molded socket shin sach foot","description":"Below knee, molded socket, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1257.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82306","name":"Vitamin d 25 hydroxy","description":"Vitamin d; 25 hydroxy, includes fraction(s), if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87580","name":"M.pneumon dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycoplasma pneumoniae, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17270","name":"Dstr mal les s/n/h/f/g .5 /<","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36254","name":"Ins cath ren art 2nd+ bilat","description":"Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, an","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1768.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83045","name":"Hgb methemoglobin qual","description":"Hemoglobin; methemoglobin, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93010","name":"Electrocardiogram report","description":"Electrocardiogram, routine ecg with at least 12 leads; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53060","name":"Drainage of urethra abscess","description":"Drainage of skenes gland abscess or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27871","name":"Fusion of tibiofibular joint","description":"Arthrodesis, tibiofibular joint, proximal or distal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73110","name":"X-ray exam of wrist","description":"Radiologic examination, wrist; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86717","name":"Leishmania antibody","description":"Antibody; leishmania","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96402","name":"Chemo hormon antineopl sq/im","description":"Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0148","name":"Scr c/v cyto, autosys, rescr","description":"Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78430","name":"Myocrd img pet rst/strs w/ct","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93976","name":"Vascular study","description":"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27685","name":"Revision of lower leg tendon","description":"Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4657","name":"Syringe w/wo needle","description":"Syringe, with or without needle, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1836","name":"Ko rigid w/o joints pre ots","description":"Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93228","name":"Remote 30 day ecg rev/report","description":"External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ecg data storage (retrievable with query) with ecg triggered and patient selected events transmitted to a remote attended surveillance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75872","name":"Vein x-ray skull epidural","description":"Venography, epidural, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22534","name":"Arthrd lat xtrcvtry tq ea ad","description":"Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP19","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3480","name":"Shoe heel pad & depress for","description":"Heel, pad and depression for spur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7007","name":"Lg vol nebulizer disposable","description":"Large volume nebulizer, disposable, unfilled, used with aerosol compressor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2602","name":"Gen w/c cushion wdth >=22 in","description":"General use wheelchair seat cushion, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34151","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1221.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92604","name":"Reprogram cochlear implt 7/>","description":"Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4233","name":"Alkalin batt for glucose mon","description":"Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6452","name":"High compres band w>=3in<5inyd","description":"High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9277","name":"External transmitter, cgm","description":"Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92228","name":"Img rta detc/mntr ds phy/qhp","description":"Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0492","name":"Tlso 3 piece rigid shell","description":"Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87206","name":"Smear fluorescent/acid stai","description":"Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4559","name":"Coupling gel or paste","description":"Coupling gel or paste, for use with ultrasound device, per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76604","name":"Us exam chest","description":"Ultrasound, chest (includes mediastinum), real time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22533","name":"Arthrd lat xtrcvtry tq lmbr","description":"Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1437.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36440","name":"Bld push tfuj 2 yr/<","description":"Push transfusion, blood, 2 years or younger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87273","name":"Herpes simplex 2 ag if","description":"Infectious agent antigen detection by immunofluorescent technique; herpes simplex virus type 2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43328","name":"Esoph fundoplasty thor","description":"Esophagogastric fundoplasty partial or complete; thoracotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27781","name":"Treatment of fibula fracture","description":"Closed treatment of proximal fibula or shaft fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0951","name":"Loop heel","description":"Heel loop/holder, any type, with or without ankle strap, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6200","name":"Elbow mold outsid lock hinge","description":"Elbow disarticulation, molded socket, outside locking hinge, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50961","name":"Ureter endoscopy & treatment","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59866","name":"Abortion (mpr)","description":"Multifetal pregnancy reduction(s) (mpr)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0948","name":"Fracture frame attachmnts ce","description":"Fracture frame, attachments for complex cervical traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21248","name":"Reconstruction of jaw","description":"Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":817.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26474","name":"Fusion of finger tendons","description":"Tenodesis; of distal joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":514.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8600","name":"Implant breast silicone/eq","description":"Implantable breast prosthesis, silicone or equal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":310.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44125","name":"Removal of small intestine","description":"Enterectomy, resection of small intestine; with enterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":975.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26951","name":"Amputation of finger/thumb","description":"Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":553.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0266","name":"Hosp bed total elec w/o matt","description":"Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11401","name":"Exc tr-ext b9+marg 0.6-1 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83036","name":"Hemoglobin glycosylated a1c","description":"Hemoglobin; glycosylated (a1c)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98961","name":"Edu&trn pt slf-mgmt nqhp 2-4","description":"Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21490","name":"Optx tmprmand dislocation","description":"Open treatment of temporomandibular dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":656.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17283","name":"Dstr mal ls f/e/e/n/l/m2.1-3","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69915","name":"Incise inner ear nerve","description":"Vestibular nerve section, translabyrinthine approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27340","name":"Removal of kneecap bursa","description":"Excision, prepatellar bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24582","name":"Prq skel fix humrl cndylr fx","description":"Percutaneous skeletal fixation of humeral condylar fracture, medial or lateral, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81020","name":"Urinalysis glass test","description":"Urinalysis; 2 or 3 glass test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73552","name":"X-ray exam of femur 2/>","description":"Radiologic examination, femur; minimum 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93314","name":"Echo transesophageal","description":"Echocardiography, transesophageal, real-time with image documentation (2d) (with or without m-mode recording); image acquisition, interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2318","name":"Lens aniseikonic trifocal","description":"Aniseikonic lens, trifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35152","name":"Repair ruptd popliteal art","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, popliteal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21014","name":"Exc face tum deep 2 cm/>","description":"Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); 2 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58570","name":"Tlh uterus 250 g or less","description":"Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":508.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54324","name":"Reconstruction of urethra","description":"1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00562","name":"Anes px hrt w/pump age 1yr+","description":"Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, age 1 year or older, for all noncoronary bypass procedures (eg, valve procedures) or for re-operation for coronary bypass more than 1 month after original operation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49600","name":"Repair umbilical lesion","description":"Repair of small omphalocele, with primary closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15786","name":"Abrasion lesion single","description":"Abrasion; single lesion (eg, keratosis, scar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28035","name":"Decompression of tibia nerve","description":"Release, tarsal tunnel (posterior tibial nerve decompression)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":428.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5646","name":"Below knee cushion socket","description":"Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8270","name":"Enuresis alarm","description":"Enuresis alarm, using auditory buzzer and/or vibration device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88307","name":"Tissue exam by pathologist","description":"Level v - surgical pathology, gross and microscopic examination adrenal, resection bone - biopsy/curettings bone fragment(s), pathologic fracture brain, biopsy brain/meninges, tumor resection breast, excision of lesion, requiring microscopic evaluation of surgical margins breast, mastectomy - partia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44055","name":"Correct malrotation of bowel","description":"Correction of malrotation by lysis of duodenal bands and/or reduction of midgut volvulus (eg, ladd procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1242.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21408","name":"Opn tx orbit fx w/bone grft","description":"Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44625","name":"Repair bowel opening","description":"Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":822.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0184T","name":"Exc rectal tumor endoscopic","description":"Excision of rectal tumor, transanal endoscopic microsurgical approach (ie, tems), including muscularis propria (ie, full thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70545","name":"Mr angiography head w/dye","description":"Magnetic resonance angiography, head; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22328","name":"Treat each add spine fx","description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95971","name":"Alys smpl sp/pn npgt w/prgrm","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0976","name":"Lso full corset","description":"Lso, full corset","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87425","name":"Rotavirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; rotavirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44650","name":"Repair bowel fistula","description":"Closure of enteroenteric or enterocolic fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27740","name":"Repair of leg epiphyses","description":"Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":597.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93246","name":"Ext ecg>7d<15d recording","description":"External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; recording (includes connection and initial recording)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11643","name":"Exc f/e/e/n/l mal+mrg 2.1-3","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27290","name":"Amputation of leg at hip","description":"Interpelviabdominal amputation (hindquarter amputation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61070","name":"Brain canal shunt procedure","description":"Puncture of shunt tubing or reservoir for aspiration or injection procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01920","name":"Anes cardiac catheterization","description":"Anesthesia for cardiac catheterization including coronary angiography and ventriculography (not to include swan-ganz catheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46220","name":"Excise anal ext tag/papilla","description":"Excision of single external papilla or tag, anus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28805","name":"Amputation thru metatarsal","description":"Amputation, foot; transmetatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36483","name":"Endoven ther chem adhes sbsq","description":"Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0114","name":"Crutch underarm pair no wood","description":"Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6502","name":"Compres burngarment chinstrp","description":"Compression burn garment, chin strap, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00834","name":"Anes hernia repair<1 yr age","description":"Anesthesia for hernia repairs in the lower abdomen not otherwise specified, younger than 1 year of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0035","name":"Cardiokymography","description":"Cardiokymography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22902","name":"Exc abd les sc < 3 cm","description":"Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93612","name":"Intraventricular pacing","description":"Intraventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4158","name":"Ef ped complete intact nut","description":"Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59015","name":"Chorion biopsy","description":"Chorionic villus sampling, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26060","name":"Incision of finger tendon","description":"Tenotomy, percutaneous, single, each digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45338","name":"Sigmoidoscopy w/tumr remove","description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP21","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32445","name":"Removal of lung extrapleural","description":"Removal of lung, pneumonectomy; extrapleural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93303","name":"Echo transthoracic","description":"Transthoracic echocardiography for congenital cardiac anomalies; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0511","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25676","name":"Optx rad/uln dislc aqt/chrnc","description":"Open treatment of distal radioulnar dislocation, acute or chronic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":530.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96373","name":"Ther/proph/diag inj ia","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45113","name":"Partial proctectomy","description":"Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (s or j), with or without loop ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1460.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21084","name":"Impres&prep sp aid prosth","description":"Impression and custom preparation; speech aid prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80166","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50780","name":"Reimplant ureter in bladder","description":"Ureteroneocystostomy; anastomosis of single ureter to bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":906.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84590","name":"Assay of vitamin a","description":"Vitamin a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30000","name":"Drainage of nose lesion","description":"Drainage abscess or hematoma, nasal, internal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48520","name":"Fuse pancreas cyst and bowel","description":"Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46910","name":"Destruction anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43192","name":"Esophagoscp rig trnso inject","description":"Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28193","name":"Removal of foot foreign body","description":"Removal of foreign body, foot; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99437","name":"Chrnc care mgmt phys ea addl","description":"Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or funct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0283","name":"Elec stim other than wound","description":"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0105","name":"Cane adjust/fixed quad/3 pro","description":"Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2377","name":"Expandable controller, initl","description":"Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82575","name":"Creatinine clearance test","description":"Creatinine; clearance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00580","name":"Anes heart/lung transplant","description":"Anesthesia for heart transplant or heart/lung transplant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00922","name":"Anes px male gent sem ves","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); seminal vesicles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26727","name":"Treat finger fracture each","description":"Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63746","name":"Removal of spinal shunt","description":"Removal of entire lumbosubarachnoid shunt system without replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77406","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13120","name":"Cmplx rpr s/a/l 1.1-2.5 cm","description":"Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":220.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21395","name":"Opn tx orbit periorbt w/grft","description":"Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46615","name":"Anoscopy","description":"Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3764","name":"Ewho w/joint(s) cf","description":"Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59200","name":"Insert cervical dilator","description":"Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33611","name":"Repair double ventricle","description":"Repair of double outlet right ventricle with intraventricular tunnel repair;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43123","name":"Partial removal of esophagus","description":"Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85410","name":"Fibrinolytic antiplasmin","description":"Fibrinolytic factors and inhibitors; alpha-2 antiplasmin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91020","name":"Gastric motility studies","description":"Gastric motility (manometric) studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70250","name":"X-ray exam of skull","description":"Radiologic examination, skull; less than 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76125","name":"Cine/video x-rays add-on","description":"Cineradiography/videoradiography to complement routine examination (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31526","name":"Dx laryngoscopy w/oper scope","description":"Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70328","name":"X-ray exam of jaw joint","description":"Radiologic examination, temporomandibular joint, open and closed mouth; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83525","name":"Assay of insulin","description":"Insulin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78492","name":"Myocrd img pet mlt rst&strs","description":"Myocardial imaging, positron emission tomography (pet), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1203.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64818","name":"Sympathectomy lumbar","description":"Sympathectomy, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":660.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84255","name":"Assay of selenium","description":"Selenium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38209","name":"Wash harvest stem cells","description":"Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27726","name":"Repair fibula nonunion","description":"Repair of fibula nonunion and/or malunion with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86709","name":"Hepatitis a igm antibody","description":"Hepatitis a antibody (haab), igm antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25275","name":"Repair forearm tendon sheath","description":"Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7364","name":"Twelve volt battery utah/equ","description":"Twelve volt battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64646","name":"Chemodenerv trunk musc 1-5","description":"Chemodenervation of trunk muscle(s); 1-5 muscle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2204","name":"Frame depth 22 to 25 in","description":"Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6935","name":"Below elbow myoelectronic ct","description":"Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00142","name":"Anes px on eye lens surgery","description":"Anesthesia for procedures on eye; lens surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30117","name":"Removal of intranasal lesion","description":"Excision or destruction (eg, laser), intranasal lesion; internal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":695.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21627","name":"Sternal debridement","description":"Sternal debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44157","name":"Colectomy w/ileoanal anast","description":"Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1835.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92342","name":"Fit spectacles multifocal","description":"Fitting of spectacles, except for aphakia; multifocal, other than bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46280","name":"Remove anal fist complex","description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4636","name":"Handgrip for cane etc","description":"Replacement, handgrip, cane, crutch, or walker, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47538","name":"Perq plmt bile duct stent","description":"Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; existing ac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3303.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85540","name":"Wbc alkaline phosphatase","description":"Leukocyte alkaline phosphatase with count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0399","name":"Home sleep test/type 3 porta","description":"Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78195","name":"Lymph system imaging","description":"Lymphatics and lymph nodes imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70200","name":"X-ray exam of eye sockets","description":"Radiologic examination; orbits, complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00916","name":"Anes trurl px rescj bleeding","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); post-transurethral resection bleeding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2208","name":"Lens sphcy bifocal 4.25-7/2.","description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44381","name":"Small bowel endoscopy br/wa","description":"Ileoscopy, through stoma; with transendoscopic balloon dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":756.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33735","name":"Revision of heart chamber","description":"Atrial septectomy or septostomy; closed heart (blalock-hanlon type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1122.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44373","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93280","name":"Pm device progr eval dual","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5979","name":"Multi-axial ankle/ft prosth","description":"All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78496","name":"Heart first pass add-on","description":"Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27393","name":"Lengthening of thigh tendon","description":"Lengthening of hamstring tendon; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":428.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78282","name":"Gi protein loss","description":"Gastrointestinal protein loss","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01170","name":"Anes opn px symph pub/si jt","description":"Anesthesia for open procedures involving symphysis pubis or sacroiliac joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57285","name":"Repair paravag defect vag","description":"Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":436.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1874","name":"Stent, coated/cov w/del sys","description":"Stent, coated/covered, with delivery system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88177","name":"Cytp fna eval ea addl","description":"Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65290","name":"Repair of eye socket wound","description":"Repair of wound, extraocular muscle, tendon and/or tenons capsule","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":294.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87172","name":"Pinworm exam","description":"Pinworm exam (eg, cellophane tape prep)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2270","name":"Varus/valgus strap padded/li","description":"Addition to lower extremity, varus/valgus correction (t) strap, padded/lined or malleolus pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29550","name":"Strapping of toes","description":"Strapping; toes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34421","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by leg incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1788","name":"Port, indwelling, imp","description":"Port, indwelling (implantable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73225","name":"Mr angio upr extr w/o&w/dye","description":"Magnetic resonance angiography, upper extremity, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4452","name":"Waterproof tape","description":"Tape, waterproof, per 18 square inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["AW","GT","GQ","95","AV","AU","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82308","name":"Assay of calcitonin","description":"Calcitonin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81344","name":"Tbp gene detc abnor alleles","description":"Tbp (tata box binding protein) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85525","name":"Heparin neutralization","description":"Heparin neutralization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93024","name":"Ergonovine provocation test","description":"Ergonovine provocation test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20606","name":"Drain/inj joint/bursa w/us","description":"Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25920","name":"Amputate hand at wrist","description":"Disarticulation through wrist;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70110","name":"X-ray exam of jaw 4/> views","description":"Radiologic examination, mandible; complete, minimum of 4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6022","name":"Collagen drsg>16<=48 sq in","description":"Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65865","name":"Incise inner eye adhesions","description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); goniosynechiae","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62290","name":"Njx px discography lumbar","description":"Injection procedure for discography, each level; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":283.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62360","name":"Insert spine infusion device","description":"Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37200","name":"Transcatheter biopsy","description":"Transcatheter biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11102","name":"Tangntl bx skin single les","description":"Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31554","name":"Laryngoplasty laryngeal sten","description":"Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1256.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95079","name":"Ingest challenge addl 60 min","description":"Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); each additional 60 minutes of testing (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2321","name":"Lenticular lens, trifocal","description":"Lenticular lens, per lens, trifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92563","name":"Tone decay hearing test","description":"Tone decay test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5624","name":"Test socket above knee","description":"Addition to lower extremity, test socket, above knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80432","name":"Insulin suppression panel","description":"Insulin-induced c-peptide suppression panel this panel must include the following: insulin (83525) c-peptide (84681 x 5) glucose (82947 x 5)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6696","name":"Cus elbo skt in for con/atyp","description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35881","name":"Revise graft w/vein","description":"Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":899.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27825","name":"Treat lower leg fracture","description":"Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":457.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0044A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29035","name":"Appl body cast sho to hips","description":"Application of body cast, shoulder to hips;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68320","name":"Revise/graft eyelid lining","description":"Conjunctivoplasty; with conjunctival graft or extensive rearrangement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6616","name":"Disconnect insert locking wr","description":"Upper extremity addition, additional disconnect insert for locking wrist unit, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27220","name":"Treat hip socket fracture","description":"Closed treatment of acetabulum (hip socket) fracture(s); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49400","name":"Air injection into abdomen","description":"Injection of air or contrast into peritoneal cavity (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68801","name":"Dilate tear duct opening","description":"Dilation of lacrimal punctum, with or without irrigation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93702","name":"Bis xtracell fluid analysis","description":"Bioimpedance spectroscopy (bis), extracellular fluid analysis for lymphedema assessment(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50620","name":"Removal of ureter stone","description":"Ureterolithotomy; middle one-third of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":731.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28234","name":"Incision of foot tendon","description":"Tenotomy, open, extensor, foot or toe, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":332.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27110","name":"Transfer of iliopsoas muscle","description":"Transfer iliopsoas; to greater trochanter of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":821.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36476","name":"Endovenous rf vein add-on","description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89220","name":"Sputum specimen collection","description":"Sputum, obtaining specimen, aerosol induced technique (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93623","name":"Prgrmd stimj&pacg iv rx nfs","description":"Programmed stimulation and pacing after intravenous drug infusion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":794.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28298","name":"Cor hlx vlgs prx phlx osteot","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal phalanx osteotomy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76826","name":"Echo exam of fetal heart","description":"Echocardiography, fetal, cardiovascular system, real time with image documentation (2d), with or without m-mode recording; follow-up or repeat study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23035","name":"Incision bone cortex sho","description":"Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":573.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17281","name":"Dstr mal ls f/e/e/n/l/m .6-1","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92524","name":"Behavral qualit analys voice","description":"Behavioral and qualitative analysis of voice and resonance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2606","name":"Position wc cush wdth>=22 in","description":"Positioning wheelchair seat cushion, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88172","name":"Cytp dx eval fna 1st ea site","description":"Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5702","name":"Replace socket hip","description":"Replacement, socket, hip disarticulation, including hip joint, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2164.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27075","name":"Resect hip tumor","description":"Radical resection of tumor; wing of ilium, 1 pubic or ischial ramus or symphysis pubis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50365","name":"Rnl altrnsplj w/rcp nfrct","description":"Renal allotransplantation, implantation of graft; with recipient nephrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33516","name":"Cabg vein six or more","description":"Coronary artery bypass, vein only; 6 or more coronary venous grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2354.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21632","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1044.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72129","name":"Ct chest spine w/dye","description":"Computed tomography, thoracic spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70120","name":"X-ray exam of mastoids","description":"Radiologic examination, mastoids; less than 3 views per side","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96450","name":"Chemotherapy into cns","description":"Chemotherapy administration, into cns (eg, intrathecal), requiring and including spinal puncture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89100","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28600","name":"Treat foot dislocation","description":"Closed treatment of tarsometatarsal joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4619","name":"Face tent","description":"Face tent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34715","name":"Opn ax/subcla art expos","description":"Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0098","name":"Drive belt for pwc, repl","description":"Drive belt for power wheelchair, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82679","name":"Assay of estrone","description":"Estrone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76821","name":"Middle cerebral artery echo","description":"Doppler velocimetry, fetal; middle cerebral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0982","name":"Stocking sup grips 4 pre ots","description":"Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7403","name":"Add ue prost b/e acrylic","description":"Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42808","name":"Excise pharynx lesion","description":"Excision or destruction of lesion of pharynx, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":177.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01622","name":"Anes dx arthr px shoulder jt","description":"Anesthesia for diagnostic arthroscopic procedures of shoulder joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5987","name":"Shank ft w vert load pylon","description":"All lower extremity prosthesis, shank foot system with vertical loading pylon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3503.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4628","name":"Oropharyngeal suction cath","description":"Oral and/or oropharyngeal suction catheter, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23550","name":"Optx acromclv dislc aqt/chrn","description":"Open treatment of acromioclavicular dislocation, acute or chronic;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":480.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75801","name":"Lymph vessel x-ray arm/leg","description":"Lymphangiography, extremity only, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":231.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2326","name":"Breath tube kit","description":"Power wheelchair accessory, breath tube kit for sip and puff interface","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35634","name":"Bpg iliorenal","description":"Bypass graft, with other than vein; iliorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1564.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19328","name":"Rmvl intact breast implant","description":"Removal of intact breast implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88237","name":"Tissue culture bone marrow","description":"Tissue culture for neoplastic disorders; bone marrow, blood cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1847","name":"Ko dbl upright w/air pre cst","description":"Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20838","name":"Replantation foot complete","description":"Replantation, foot, complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2367.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27246","name":"Treat thigh fracture","description":"Closed treatment of greater trochanteric fracture, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21930","name":"Exc back les sc < 3 cm","description":"Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27734","name":"Repair lower leg epiphyses","description":"Arrest, epiphyseal (epiphysiodesis), open; distal tibia and fibula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61516","name":"Crnec treph exc cyst sttl","description":"Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1710.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95886","name":"Musc test done w/n test comp","description":"Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (list separately in addition to code for ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31080","name":"Removal of frontal sinus","description":"Sinusotomy frontal; obliterative without osteoplastic flap, brow incision (includes ablation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36821","name":"Av fusion direct any site","description":"Arteriovenous anastomosis, open; direct, any site (eg, cimino type) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27240","name":"Treat thigh fracture","description":"Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":806.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65280","name":"Repair of eye wound","description":"Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90997","name":"Hemoperfusion","description":"Hemoperfusion (eg, with activated charcoal or resin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11008","name":"Rmv prstc mtrl/mesh abd wall","description":"Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23515","name":"Optx clavicular fx w/int fix","description":"Open treatment of clavicular fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49654","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":705.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4357","name":"Bedside drainage bag","description":"Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27202","name":"Treat tail bone fracture","description":"Open treatment of coccygeal fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32601","name":"Thoracoscopy diagnostic","description":"Thoracoscopy, diagnostic (separate procedure); lungs, pericardial sac, mediastinal or pleural space, without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5430","name":"Postop dsg ak ea add cast ch","description":"Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, ak or knee disarticulation, each additional cast change and realignment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":333.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44314","name":"Revision of ileostomy","description":"Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14301","name":"Tis trnfr any 30.1-60 sq cm","description":"Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":677.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27447","name":"Total knee arthroplasty","description":"Arthroplasty, knee, condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1148.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96020","name":"Functional brain mapping","description":"Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4314","name":"Cath w/drainage 2-way latex","description":"Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87275","name":"Influenza b ag if","description":"Infectious agent antigen detection by immunofluorescent technique; influenza b virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96159","name":"Hlth bhv ivntj indiv ea addl","description":"Health behavior intervention, individual, face-to-face; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11920","name":"Correct skin color 6.0 cm/<","description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93655","name":"Icar cath abltj dscrt arrhyt","description":"Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2005","name":"Kafo sng/dbl mechanical act","description":"Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1992.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22114","name":"Remove part lumbar vertebra","description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64862","name":"Repair of low back nerves","description":"Suture of; lumbar plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91111","name":"Gi trc img intral esophagus","description":"Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24931","name":"Amputate upper arm & implant","description":"Amputation, arm through humerus; with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58570","name":"Tlh uterus 250 g or less","description":"Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00756","name":"Anes hrna rpr diphrg hrna","description":"Anesthesia for hernia repairs in upper abdomen; transabdominal repair of diaphragmatic hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50434","name":"Convert nephrostomy catheter","description":"Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, via pre-existing nephrostomy tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88311","name":"Decalcify tissue","description":"Decalcification procedure (list separately in addition to code for surgical pathology examination)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92550","name":"Tympanometry & reflex thresh","description":"Tympanometry and reflex threshold measurements","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31614","name":"Tracheostoma revj complex","description":"Tracheostoma revision; complex, with flap rotation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88374","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23450","name":"Repair shoulder capsule","description":"Capsulorrhaphy, anterior; putti-platt procedure or magnuson type operation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":802.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92522","name":"Evaluate speech production","description":"Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0566T","name":"Autol cell implt adps njx","description":"Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78007","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1236","name":"Folding ped wc adjustable","description":"Wheelchair, pediatric size, folding, adjustable, with seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81234","name":"Dmpk gene detc abnor allele","description":"Dmpk (dm1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal (expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61595","name":"Transtemporal approach/skull","description":"Transtemporal approach to posterior cranial fossa, jugular foramen or midline skull base, including mastoidectomy, decompression of sigmoid sinus and/or facial nerve, with or without mobilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2025.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68135","name":"Destruction les conjunctiva","description":"Destruction of lesion, conjunctiva","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77522","name":"Proton trmt simple w/comp","description":"Proton treatment delivery; simple, with compensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43259","name":"Egd us exam duodenum/jejunum","description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46261","name":"Remove in/ex hem grps & fiss","description":"Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74021","name":"Radex abdomen 3+ views","description":"Radiologic examination, abdomen; 3 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67413","name":"Explore/treat eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94618","name":"Pulmonary stress testing","description":"Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4130","name":"Replace pretibial shell","description":"Replace pretibial shell","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1851","name":"Ko single upright prefab ots","description":"Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52281","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42408","name":"Excision of salivary cyst","description":"Excision of sublingual salivary cyst (ranula)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":402.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36012","name":"Place catheter in vein","description":"Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36223","name":"Place cath carotid/inom art","description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1313.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00797","name":"Anes iper upr abd gstr px mo","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27095","name":"Injection for hip x-ray","description":"Injection procedure for hip arthrography; with anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83916","name":"Oligoclonal bands","description":"Oligoclonal immune (oligoclonal bands)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44010","name":"Incision of small bowel","description":"Duodenotomy, for exploration, biopsy(s), or foreign body removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24546","name":"Optx hum fx w/ntrcndylr xtn","description":"Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; with intercondylar extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90818","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53250","name":"Removal of urethra gland","description":"Excision of bulbourethral gland (cowpers gland)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82360","name":"Calculus assay quant","description":"Calculus; quantitative analysis, chemical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15776","name":"Hair trnspl >15 punch grafts","description":"Punch graft for hair transplant; more than 15 punch grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":322.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95822","name":"Eeg coma or sleep only","description":"Electroencephalogram (eeg); recording in coma or sleep only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36590","name":"Removal tunneled cv cath","description":"Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2015","name":"Post-d/c care plan overs 60m","description":"Comprehensive (60 mins) home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2630","name":"Pelvic control band & belt u","description":"Addition to lower extremity, pelvic control, band and belt, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33271","name":"Insj subq impltbl dfb elctrd","description":"Insertion of subcutaneous implantable defibrillator electrode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44385","name":"Endoscopy of bowel pouch","description":"Endoscopic evaluation of small intestinal pouch (eg, kock pouch, ileal reservoir [s or j]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67107","name":"Repair detached retina","description":"Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), including, when performed, implant, cryotherapy, photocoagulation, and drainage of subretinal fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35091","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15793","name":"Chemical peel nonfacial drm","description":"Chemical peel, nonfacial; dermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":299.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1031","name":"Rollabout chair with casters","description":"Rollabout chair, any and all types with casters 5 or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85530","name":"Heparin-protamine tolerance","description":"Heparin-protamine tolerance test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4110","name":"Repl leath cuff kafo-afo cal","description":"Replace leather cuff kafo-afo, calf or distal thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67550","name":"Insert eye socket implant","description":"Orbital implant (implant outside muscle cone); insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":620.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61531","name":"Implant brain electrodes","description":"Subdural implantation of strip electrodes through 1 or more burr or trephine hole(s) for long-term seizure monitoring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1109.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27486","name":"Revise/replace knee joint","description":"Revision of total knee arthroplasty, with or without allograft; 1 component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26593","name":"Release muscles of hand","description":"Release, intrinsic muscles of hand, each muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35685","name":"Bypass graft patency/patch","description":"Placement of vein patch or cuff at distal anastomosis of bypass graft, synthetic conduit (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86698","name":"Histoplasma antibody","description":"Antibody; histoplasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68525","name":"Biopsy of tear sac","description":"Biopsy of lacrimal sac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":158.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31775","name":"Reconstruct bronchus","description":"Bronchoplasty; excision stenosis and anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1117.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20902","name":"Removal of bone for graft","description":"Bone graft, any donor area; major or large","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":238.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93452","name":"Left hrt cath w/ventrclgrphy","description":"Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64896","name":"Nrv grf mltst hnd/foot >4 cm","description":"Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33321","name":"Repair major vessel","description":"Suture repair of aorta or great vessels; with shunt bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90962","name":"Esrd serv 1 visit p mo 20+","description":"End-stage renal disease (esrd) related services monthly, for patients 20 years of age and older; with 1 face-to-face visit by a physician or other qualified health care professional per month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12007","name":"Rpr s/n/ax/gen/trnk >30.0 cm","description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0630","name":"Lso r post pnl sj-t9 pre cst","description":"Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8030","name":"Breast prosthes w/o adhesive","description":"Breast prosthesis, silicone or equal, without integral adhesive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88185","name":"Flowcytometry/tc add-on","description":"Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (list separately in addition to code for first marker)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6965","name":"Shldr disartic myoelectronic","description":"Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3933","name":"Fo w/o joints cf","description":"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61703","name":"Clamp neck artery","description":"Surgery of intracranial aneurysm, cervical approach by application of occluding clamp to cervical carotid artery (selverstone-crutchfield type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61601","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; intradural, including dural repair, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2158.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29838","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; debridement, extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5726","name":"Knee-shin ext jnts fld swg e","description":"Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":863.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75635","name":"Ct angio abdominal arteries","description":"Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34471","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; subclavian vein, by neck incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36582","name":"Replace tunneled cv cath","description":"Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30460","name":"Revision of nose","description":"Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":637.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01992","name":"Anes dx/ther nrv blk&inj prn","description":"Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); prone position","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5122","name":"Solid skin barrier 8x8","description":"Skin barrier; solid, 8 x 8 or equivalent, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89051","name":"Body fluid cell count","description":"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43770","name":"Lap place gastr adj device","description":"Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87481","name":"Candida dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); candida species, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28576","name":"Treat foot dislocation","description":"Percutaneous skeletal fixation of talotarsal joint dislocation, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5301","name":"Bk mold socket sach ft endo","description":"Below knee, molded socket, shin, sach foot, endoskeletal system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1139.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50436","name":"Dilat xst trc ndurlgc px","description":"Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24666","name":"Optx radial head/nck fx rplc","description":"Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; with radial head prosthetic replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":616.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33206","name":"Insert heart pm atrial","description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64635","name":"Destroy lumb/sac facet jnt","description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); lumbar or sacral, single facet joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82731","name":"Assay of fetal fibronectin","description":"Fetal fibronectin, cervicovaginal secretions, semi-quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58152","name":"Total hysterectomy","description":"Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, marshall-marchetti-krantz, burch)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":805.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9040","name":"Rbc leukoreduced irradiated","description":"Red blood cells, leukocytes reduced, irradiated, each unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29837","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; debridement, limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":442.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55120","name":"Removal of scrotum lesion","description":"Removal of foreign body in scrotum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44373","name":"Small bowel endoscopy","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50845","name":"Appendico-vesicostomy","description":"Cutaneous appendico-vesicostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74000","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66635","name":"Removal of iris","description":"Iridectomy, with corneoscleral or corneal section; optical (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":344.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26123","name":"Release palm contracture","description":"Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":696.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27598","name":"Amputate lower leg at knee","description":"Disarticulation at knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":613.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57150","name":"Treat vagina infection","description":"Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77295","name":"3-d radiotherapy plan","description":"3-dimensional radiotherapy plan, including dose-volume histograms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5503","name":"Diabetic shoe w/roller/rockr","description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64783","name":"Limb nerve surgery add-on","description":"Excision of neuroma; hand or foot, each additional nerve, except same digit (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97033","name":"App mdlty 1+iontphrsis ea 15","description":"Application of a modality to 1 or more areas; iontophoresis, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54304","name":"Revision of penis","description":"Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0633","name":"Lso sc r pos/lat pnl pre cst","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, clo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6230","name":"Gauze > 48 sq in water/salne","description":"Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54435","name":"Revision of penis","description":"Corpora cavernosa-glans penis fistulization (eg, biopsy needle, winter procedure, rongeur, or punch) for priapism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82962","name":"Glucose blood test","description":"Glucose, blood by glucose monitoring device(s) cleared by the fda specifically for home use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54861","name":"Removal of epididymis","description":"Epididymectomy; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35697","name":"Reimplant artery each","description":"Reimplantation, visceral artery to infrarenal aortic prosthesis, each artery (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54316","name":"Reconstruction of urethra","description":"Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft obtained from site other than genitalia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":805.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88365","name":"Insitu hybridization (fish)","description":"In situ hybridization (eg, fish), per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61750","name":"Incise skull/brain biopsy","description":"Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1285.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97001","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20552","name":"Njx 1/mlt trigger point 1/2","description":"Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88344","name":"Imhchem/imcytchm ea mlt antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20702","name":"Mnl prep&insj imed rx dev","description":"Manual preparation and insertion of drug-delivery device(s), intramedullary (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3909","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0498","name":"Holster elec/combo vad, rep","description":"Holster for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4721","name":"Dialysat sol fld vol > 999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74240","name":"X-ray xm upr gi trc 1cntrst","description":"Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15840","name":"Nerve palsy fascial graft","description":"Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5705","name":"Custom shape cover ak","description":"Custom shaped protective cover, above knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":517.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61863","name":"Implant neuroelectrode","description":"Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1368.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0190","name":"Cerv collar supp adj cerv ba","description":"Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35011","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, axillary-brachial artery, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":881.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31529","name":"Laryngoscopy and dilation","description":"Laryngoscopy direct, with or without tracheoscopy; with dilation, subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":120.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90969","name":"Esrd svc pr day pt 12-19","description":"End-stage renal disease (esrd) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47542","name":"Dilate biliary duct/ampulla","description":"Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15175","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6635","name":"Lift assist for elbow","description":"Upper extremity addition, lift assist for elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20240","name":"Bone biopsy open superficial","description":"Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29886","name":"Arthrs knee surg drlg od les","description":"Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8514","name":"Repl trach puncture dilator","description":"Tracheoesophageal puncture dilator, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32656","name":"Thoracoscopy w/pleurectomy","description":"Thoracoscopy, surgical; with parietal pleurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":638.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43280","name":"Laparoscopy fundoplasty","description":"Laparoscopy, surgical, esophagogastric fundoplasty (eg, nissen, toupet procedures)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52353","name":"Cystouretero w/lithotripsy","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":316.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93592","name":"Perq transcath closure each","description":"Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2800","name":"Knee cap medial or lateral p","description":"Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0043","name":"Ftrst lowr exten tube rep ea","description":"Footrest, lower extension tube, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6055","name":"Wrst mold sock w/exp interfa","description":"Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28456","name":"Prq skel fix tarsl fx w/mnpj","description":"Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":281.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44121","name":"Removal of small intestine","description":"Enterectomy, resection of small intestine; each additional resection and anastomosis (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28445","name":"Optx talus fracture","description":"Open treatment of talus fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28510","name":"Treatment of toe fracture","description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19103","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8684","name":"Radiof trsmtr implt scrl neu","description":"Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31750","name":"Tracheoplasty cervical","description":"Tracheoplasty; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1033.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30460","name":"Revision of nose","description":"Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50715","name":"Release of ureter","description":"Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55600","name":"Vesiculotomy","description":"Vesiculotomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72100","name":"X-ray exam l-s spine 2/3 vws","description":"Radiologic examination, spine, lumbosacral; 2 or 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44950","name":"Appendectomy","description":"Appendectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":535.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63704","name":"Repair of spinal herniation","description":"Repair of myelomeningocele; less than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1505.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93572","name":"Iv dop vel&/press c flo ea","description":"Intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, when performed; each additional vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35189","name":"Rpr acq av fistula thrx&abd","description":"Repair, acquired or traumatic arteriovenous fistula; thorax and abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86902","name":"Blood type antigen donor ea","description":"Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26546","name":"Repair nonunion hand","description":"Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or internal fixation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86305","name":"Human epididymis protein 4","description":"Human epididymis protein 4 (he4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78232","name":"Salivary gland function std","description":"Salivary gland function study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4404","name":"Ostomy ring each","description":"Ostomy ring, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11730","name":"Avulsion nail plate simple 1","description":"Avulsion of nail plate, partial or complete, simple; single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5661","name":"Multi-durometer symes","description":"Addition to lower extremity, socket insert, multi-durometer symes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66987","name":"Xcapsl ctrc rmvl cplx w/ecp","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96160","name":"Pt-focused hlth risk assmt","description":"Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21602","name":"Exc ch wal tum w/o lymphadec","description":"Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35686","name":"Bypass graft/av fist patency","description":"Creation of distal arteriovenous fistula during lower extremity bypass surgery (non-hemodialysis) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73590","name":"X-ray exam of lower leg","description":"Radiologic examination; tibia and fibula, 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86727","name":"Lymph choriomeningitis ab","description":"Antibody; lymphocytic choriomeningitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83921","name":"Organic acid single quant","description":"Organic acid, single, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49421","name":"Ins tun ip cath for dial opn","description":"Insertion of tunneled intraperitoneal catheter for dialysis, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82127","name":"Amino acid single qual","description":"Amino acids; single, qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4565","name":"Slings","description":"Slings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2513","name":"Contact lens extended wear","description":"Contact lens, gas permeable, extended wear, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23491","name":"Reinforce shoulder bones","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; proximal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":859.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31611","name":"Constj trachesophgl fstl","description":"Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (eg, voice button, blom-singer prosthesis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24802","name":"Arthrd elbow jt autog graft","description":"Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":848.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0499T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72156","name":"Mri neck spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54130","name":"Remove penis & nodes","description":"Amputation of penis, radical; with bilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0504T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69715","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1059.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93296","name":"Rem interrog evl pm/ids","description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2182","name":"Drop lock knee","description":"Addition to lower extremity fracture orthosis, drop lock knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94360","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3649","name":"Orthopedic shoe modifica nos","description":"Orthopedic shoe, modification, addition or transfer, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80412","name":"Crh stimulation panel","description":"Corticotropic releasing hormone (crh) stimulation panel this panel must include the following: cortisol (82533 x 6) adrenocorticotropic hormone (acth) (82024 x 6)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21012","name":"Exc face les sbq 2 cm/>","description":"Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":283.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63283","name":"Bx/exc idrl spine lesn scrl","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1736.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35907","name":"Excision graft abdomen","description":"Excision of infected graft; abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1681.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77610","name":"Hyperthermia ntrstl prb 5/<","description":"Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1355","name":"Oxygen supplies stand/rack","description":"Stand/rack","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44188","name":"Lap colostomy","description":"Laparoscopy, surgical, colostomy or skin level cecostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62323","name":"Njx interlaminar lmbr/sac","description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluorosc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21347","name":"Opn tx nasomax fx multple","description":"Open treatment of nasomaxillary complex fracture (lefort ii type); requiring multiple open approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83013","name":"H pylori (c-13) breath","description":"Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, c-13)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40845","name":"Reconstruction of mouth","description":"Vestibuloplasty; complex (including ridge extension, muscle repositioning)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1140.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10140","name":"I&d hmtma seroma/fluid collj","description":"Incision and drainage of hematoma, seroma or fluid collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6209","name":"Foam drsg <=16 sq in w/o bdr","description":"Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2744","name":"Tint photochromatic lens/es","description":"Tint, photochromatic, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92504","name":"Ear microscopy examination","description":"Binocular microscopy (separate diagnostic procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2390","name":"Solid drive wheel tire","description":"Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67906","name":"Repair eyelid defect","description":"Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93287","name":"Peri-px device eval & prgr","description":"Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00450","name":"Anes px clav&scapula nos","description":"Anesthesia for procedures on clavicle and scapula; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83033","name":"Hemoglobin ftl f assay qual","description":"Hemoglobin; f (fetal), qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33261","name":"Ablate heart dysrhythm focus","description":"Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0821","name":"Pwc gp 2 std port cap chair","description":"Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97165","name":"Ot eval low complex 30 min","description":"Occupational therapy evaluation, low complexity, requiring these components: an occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; an assessment(s) that identifies 1-3 performance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6211","name":"Foam drg > 48 sq in w/o brdr","description":"Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26433","name":"Repair finger tendon","description":"Repair of extensor tendon, distal insertion, primary or secondary; without graft (eg, mallet finger)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28289","name":"Corrj halux rigdus w/o implt","description":"Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":581.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35645","name":"Bpg subclavian-vertebral","description":"Bypass graft, with other than vein; subclavian-vertebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":834.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0839","name":"Pwc gp2 vhd sing pow opt s/b","description":"Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29705","name":"Rmvl/bivlv full arm/leg cast","description":"Removal or bivalving; full arm or full leg cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43887","name":"Gstr rstcv px opn rmvl port","description":"Gastric restrictive procedure, open; removal of subcutaneous port component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44300","name":"Open bowel to skin","description":"Placement, enterostomy or cecostomy, tube open (eg, for feeding or decompression) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":702.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43331","name":"Esophagomyotomy thoracic","description":"Esophagomyotomy (heller type); thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1107.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1751","name":"Cath, inf, per/cent/midline","description":"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99457","name":"Rpm tx mgmt 1st 20 min","description":"Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring 1 real-time interactive communication with the patient/caregiver during the calendar month; first 20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83018","name":"Heavy metal quan each nes","description":"Heavy metal (eg, antimony, arsenic, barium, beryllium, bismuth, gadolinium, mercury); quantitative, each, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96401","name":"Chemo anti-neopl sq/im","description":"Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87899","name":"Agent nos assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4649","name":"Surgical supplies","description":"Surgical supply; miscellaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0121","name":"Colon ca scrn not hi rsk ind","description":"Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","53",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21450","name":"Cltx mndblr fx w/o mnpj","description":"Closed treatment of mandibular fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0147T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":361.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27066","name":"Remove hip bone les deep","description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; deep (subfascial), includes autograft, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66185","name":"Revise aqueous shunt eye","description":"Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":509.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58300","name":"Insert intrauterine device","description":"Insertion of intrauterine device (iud)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40830","name":"Repair mouth laceration","description":"Closure of laceration, vestibule of mouth; 2.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40820","name":"Treatment of mouth lesion","description":"Destruction of lesion or scar of vestibule of mouth by physical methods (eg, laser, thermal, cryo, chemical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77011","name":"Ct scan for localization","description":"Computed tomography guidance for stereotactic localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4721","name":"Dialysat sol fld vol > 999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12044","name":"Intmd rpr n-hf/genit7.6-12.5","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3209","name":"Surgical boot each child","description":"Surgical boot, each, child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36515","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1659.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21552","name":"Exc neck les sc 3 cm/>","description":"Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75716","name":"Artery x-rays arms/legs","description":"Angiography, extremity, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76010","name":"X-ray nose to rectum","description":"Radiologic examination from nose to rectum for foreign body, single view, child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94011","name":"Spirometry up to 2 yrs old","description":"Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73522","name":"X-ray exam hips bi 3-4 views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95705","name":"Eeg w/o vid 2-12 hr unmntr","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, 2-12 hours; unmonitored","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99195","name":"Phlebotomy","description":"Phlebotomy, therapeutic (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":76.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00944","name":"Anes vag px vag hysterectomy","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); vaginal hysterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9981","name":"Remote e/m new pt 45mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28104","name":"Removal of foot lesion","description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01490","name":"Anes lwr leg cst app rmv/rpr","description":"Anesthesia for lower leg cast application, removal, or repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78456","name":"Acute venous thrombus image","description":"Acute venous thrombosis imaging, peptide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25565","name":"Cltx rdl&uln shft fx w/mnpj","description":"Closed treatment of radial and ulnar shaft fractures; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00404","name":"Anes integ sys rad/modf brst","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32506","name":"Wedge resect of lung add-on","description":"Thoracotomy; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73070","name":"X-ray exam of elbow","description":"Radiologic examination, elbow; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84252","name":"Assay of vitamin b-2","description":"Riboflavin (vitamin b-2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6805","name":"Term dev modifier wrist unit","description":"Addition to terminal device, modifier wrist unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21145","name":"Rcnstj mdfc lefort i 1 w/grf","description":"Reconstruction midface, lefort i; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1246.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59160","name":"D & c after delivery","description":"Curettage, postpartum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":207.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11765","name":"Wedge excision skn nail fold","description":"Wedge excision of skin of nail fold (eg, for ingrown toenail)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33948","name":"Ecmo/ecls daily mgmt-venous","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; daily management, each day, veno-venous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22867","name":"Insj stablj dev w/dcmprn","description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":861.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1035","name":"Patient transfer system <300","description":"Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0570","name":"Nebulizer with compression","description":"Nebulizer, with compressor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38520","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4040","name":"Replace molded thigh lacer","description":"Replace molded thigh lacer, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0454","name":"Tlso trnk sj-t9 pre cst","description":"Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61458","name":"Crnec sopl xpl/dcmpr crl nrv","description":"Craniectomy, suboccipital; for exploration or decompression of cranial nerves","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36831","name":"Open thrombect av fistula","description":"Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":540.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74221","name":"X-ray xm esophagus 2cntrst","description":"Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01732","name":"Anes dx arthrs px elbow jt","description":"Anesthesia for diagnostic arthroscopic procedures of elbow joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8688","name":"Implt nrostm pls gen dua non","description":"Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5288.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76857","name":"Us exam pelvic limited","description":"Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33945","name":"Transplantation of heart","description":"Heart transplant, with or without recipient cardiectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4254.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90880","name":"Hypnotherapy","description":"Hypnotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0472T","name":"Prgrmg io rta eltrd ra","description":"Device evaluation, interrogation, and initial programming of intraocular retinal electrode array (eg, retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with r","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90832","name":"Psytx w pt 30 minutes","description":"Psychotherapy, 30 minutes with patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96921","name":"Excimer lsr psriasis 250-500","description":"Excimer laser treatment for psoriasis; 250 sq cm to 500 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33018","name":"Prcrd drg 0-5yr or w/anomly","description":"Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; birth through 5 years of age or any age with congenital cardiac anomaly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95170","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole body extract of biting insect or other arthropod (specify number of doses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6625","name":"Rotation wrst w/ cable lock","description":"Upper extremity addition, rotation wrist unit with cable lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59870","name":"Evacuate mole of uterus","description":"Uterine evacuation and curettage for hydatidiform mole","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":580.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0042","name":"Standard size ftplate rep ea","description":"Standard size footplate, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27275","name":"Manipulation of hip joint","description":"Manipulation, hip joint, requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87350","name":"Hepatitis be ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; hepatitis be antigen (hbeag)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72084","name":"X-ray exam entire spi 6/> vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); minimum of 6 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92371","name":"Rpr&refit spct prsth aphakia","description":"Repair and refitting spectacles; spectacle prosthesis for aphakia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21603","name":"Exc ch wal tum w/lymphadec","description":"Excision of chest wall tumor involving rib(s), with plastic reconstruction; with mediastinal lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47552","name":"Biliary endo perq dx w/speci","description":"Biliary endoscopy, percutaneous via t-tube or other tract; diagnostic, with collection of specimen(s) by brushing and/or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93458","name":"L hrt artery/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1076.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0760","name":"Osteogen ultrasound stimltor","description":"Osteogenesis stimulator, low intensity ultrasound, non-invasive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26437","name":"Realignment of tendons","description":"Realignment of extensor tendon, hand, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62010","name":"Treatment of head injury","description":"Elevation of depressed skull fracture; with repair of dura and/or debridement of brain","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1399.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93888","name":"Intracranial limited study","description":"Transcranial doppler study of the intracranial arteries; limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2402","name":"Neg press wound therapy pump","description":"Negative pressure wound therapy electrical pump, stationary or portable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82373","name":"Assay c-d transfer measure","description":"Carbohydrate deficient transferrin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19380","name":"Revj reconstructed breast","description":"Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43830","name":"Gstrst open wo constj tube","description":"Gastrostomy, open; without construction of gastric tube (eg, stamm procedure) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":582.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87420","name":"Resp syncytial virus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4373","name":"Skin barrier with flange","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67210","name":"Treatment of retinal lesion","description":"Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99202","name":"Office o/p new sf 15 min","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 15 minutes must be met or exceede","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26492","name":"Tendon transfer with graft","description":"Opponensplasty; tendon transfer with graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":752.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84145","name":"Procalcitonin (pct)","description":"Procalcitonin (pct)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67550","name":"Insert eye socket implant","description":"Orbital implant (implant outside muscle cone); insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00326","name":"Anes all px larynx&trach<1yr","description":"Anesthesia for all procedures on the larynx and trachea in children younger than 1 year of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64719","name":"Revise ulnar nerve at wrist","description":"Neuroplasty and/or transposition; ulnar nerve at wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27390","name":"Incision of thigh tendon","description":"Tenotomy, open, hamstring, knee to hip; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":376.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73562","name":"X-ray exam of knee 3","description":"Radiologic examination, knee; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86870","name":"Rbc antibody identification","description":"Antibody identification, rbc antibodies, each panel for each serum technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7504","name":"Tracheostoma hmes filter","description":"Filter for use in a tracheostoma heat and moisture exchange system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15780","name":"Dermabrasion total face","description":"Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23473","name":"Revis reconst shoulder joint","description":"Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69905","name":"Remove inner ear","description":"Labyrinthectomy; transcanal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":739.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97763","name":"Orthc/prostc mgmt sbsq enc","description":"Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4490","name":"Above knee surgical stocking","description":"Surgical stockings above knee length, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87631","name":"Resp virus 3-5 targets","description":"Infectious agent detection by nucleic acid (dna or rna); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19355","name":"Correct inverted nipple(s)","description":"Correction of inverted nipples","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":483.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32200","name":"Drain open lung lesion","description":"Pneumonostomy, with open drainage of abscess or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":904.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73719","name":"Mri lower extremity w/dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21160","name":"Rcnst mdfc lfrtiii advm w/i","description":"Reconstruction midface, lefort iii (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with lefort i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2299.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51565","name":"Revise bladder & ureter(s)","description":"Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15111","name":"Epidrm agrft t/a/l ea addl","description":"Epidermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33660","name":"Repair of heart defects","description":"Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal defect), with or without atrioventricular valve repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1528.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61615","name":"Resect/excise lesion skull","description":"Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or c1-c3 vertebral bodies; extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97024","name":"Diathermy eg microwave","description":"Application of a modality to 1 or more areas; diathermy (eg, microwave)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26525","name":"Release finger contracture","description":"Capsulectomy or capsulotomy; interphalangeal joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4360","name":"Disposable ext urethral dev","description":"Disposable external urethral clamp or compression device, with pad and/or pouch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1499","name":"Spinal orthosis nos","description":"Spinal orthosis, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01210","name":"Anes open px hip joint nos","description":"Anesthesia for open procedures involving hip joint; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4224","name":"Parenteral administration ki","description":"Parenteral nutrition administration kit, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85260","name":"Clot factor x stuart-power","description":"Clotting; factor x (stuart-prower)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43756","name":"Dx duod intub w/asp spec","description":"Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (eg, bile study for crystals or afferent loop culture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24102","name":"Arthrt elbow w/synovectomy","description":"Arthrotomy, elbow; with synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67145","name":"Proph rta dtchmnt pc","description":"Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":318.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89220","name":"Sputum specimen collection","description":"Sputum, obtaining specimen, aerosol induced technique (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29835","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; synovectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43264","name":"Ercp remove duct calculi","description":"Endoscopic retrograde cholangiopancreatography (ercp); with removal of calculi/debris from biliary/pancreatic duct(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64866","name":"Fusion of facial/other nerve","description":"Anastomosis; facial-spinal accessory","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23570","name":"Cltx scapular fx w/o mnpj","description":"Closed treatment of scapular fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21030","name":"Excise max/zygoma b9 tumor","description":"Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33665","name":"Repair of heart defects","description":"Repair of intermediate or transitional atrioventricular canal, with or without atrioventricular valve repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86308","name":"Heterophile antibody screen","description":"Heterophile antibodies; screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87529","name":"Hsv dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); herpes simplex virus, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2301","name":"Pwr standing","description":"Wheelchair accessory, power standing system, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76800","name":"Us exam spinal canal","description":"Ultrasound, spinal canal and contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99348","name":"Home/res vst est low mdm 30","description":"Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95711","name":"Veeg 2-12 hr unmonitored","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, 2-12 hours; unmonitored","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33413","name":"Replacement of aortic valve","description":"Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (ross procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2813.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0783","name":"Programmable infusion pump","description":"Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0824","name":"Pwc gp 2 hd seat/back","description":"Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0148","name":"Heavyduty walker no wheels","description":"Walker, heavy duty, without wheels, rigid or folding, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2113","name":"Spherocylindr 7.25d/4.25-6d","description":"Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81413","name":"Car ion chnnlpath inc 10 gns","description":"Cardiac ion channelopathies (eg, brugada syndrome, long qt syndrome, short qt syndrome, catecholaminergic polymorphic ventricular tachycardia); genomic sequence analysis panel, must include sequencing of at least 10 genes, including ank2, casq2, cav3, kcne1, kcne2, kcnh2, kcnj2, kcnq1, ryr2, and scn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":324.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88108","name":"Cytopath concentrate tech","description":"Cytopathology, concentration technique, smears and interpretation (eg, saccomanno technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2070","name":"Hkafo torsion unilat rot str","description":"Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5980","name":"Flex foot system","description":"All lower extremity prostheses, flex foot system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94150","name":"Vital capacity test","description":"Vital capacity, total (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27006","name":"Tenotomy abductor&/xtnsr hip","description":"Tenotomy, abductors and/or extensor(s) of hip, open (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":595.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80299","name":"Quantitative assay drug","description":"Quantitation of therapeutic drug, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0972","name":"Lso corset front","description":"Lso, corset front","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8035","name":"Custom breast prosthesis","description":"Custom breast prosthesis, post mastectomy, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45541","name":"Correct rectal prolapse","description":"Proctopexy (eg, for prolapse); perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":762.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92625","name":"Tinnitus assessment","description":"Assessment of tinnitus (includes pitch, loudness matching, and masking)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6255","name":"Absorpt drg >16<=48 in w/bdr","description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21137","name":"Rdctj forehead cntrg only","description":"Reduction forehead; contouring only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27675","name":"Repair lower leg tendons","description":"Repair, dislocating peroneal tendons; without fibular osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":400.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76391","name":"Mr elastography","description":"Magnetic resonance (eg, vibration) elastography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64569","name":"Revise/repl vagus n eltrd","description":"Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":672.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93464","name":"Exercise w/hemodynamic meas","description":"Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42802","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46706","name":"Repr of anal fistula w/glue","description":"Repair of anal fistula with fibrin glue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36248","name":"Ins cath abd/l-ext art addl","description":"Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50650","name":"Removal of ureter","description":"Ureterectomy, with bladder cuff (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99490","name":"Chrnc care mgmt staff 1st 20","description":"Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or funct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65103","name":"Remove eye/insert implant","description":"Enucleation of eye; with implant, muscles not attached to implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":497.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78195","name":"Lymph system imaging","description":"Lymphatics and lymph nodes imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1031","name":"Rollabout chair with casters","description":"Rollabout chair, any and all types with casters 5 or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27179","name":"Revise head/neck of femur","description":"Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (heyman type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":827.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50900","name":"Repair of ureter","description":"Ureterorrhaphy, suture of ureter (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":680.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7038","name":"Pos airway pressure filter","description":"Filter, disposable, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00222","name":"Anes icr px ecoag icr nrv","description":"Anesthesia for intracranial procedures; electrocoagulation of intracranial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1220","name":"Anterior thoracic extension","description":"Addition to tlso, (low profile), anterior thoracic extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26952","name":"Amputation of finger/thumb","description":"Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (v-y, hood)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":545.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84540","name":"Assay of urine/urea-n","description":"Urea nitrogen, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25085","name":"Incision of wrist capsule","description":"Capsulotomy, wrist (eg, contracture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":374.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86747","name":"Parvovirus antibody","description":"Antibody; parvovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43198","name":"Esophagosc flex trnsn biopsy","description":"Esophagoscopy, flexible, transnasal; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9537","name":"Tc99m mebrofenin","description":"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27664","name":"Repair of leg tendon each","description":"Repair, extensor tendon, leg; primary, without graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6238","name":"Hydrocolld drg >16<=48 w/bdr","description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0171","name":"Commode chair non-electric","description":"Commode chair with integrated seat lift mechanism, non-electric, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70492","name":"Ct sft tsue nck w/o & w/dye","description":"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36015","name":"Place catheter in artery","description":"Selective catheter placement, segmental or subsegmental pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37247","name":"Trluml balo angiop addl art","description":"Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35571","name":"Art byp pop-tibl-prl-other","description":"Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1168.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46210","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41823","name":"Excision of gum lesion","description":"Excision of osseous tuberosities, dentoalveolar structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L9900","name":"O&p supply/accessory/service","description":"Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs l code","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15950","name":"Exc trchntr pr ulc prim sutr","description":"Excision, trochanteric pressure ulcer, with primary suture;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83021","name":"Hemoglobin chromotography","description":"Hemoglobin fractionation and quantitation; chromatography (eg, a2, s, c, and/or f)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6407","name":"Packing strips, non-impreg","description":"Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93986","name":"Dup-scan hemo compl uni std","description":"Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71271","name":"Ct thorax lung cancer scr c-","description":"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":117.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85611","name":"Prothrombin test","description":"Prothrombin time; substitution, plasma fractions, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86709","name":"Hepatitis a igm antibody","description":"Hepatitis a antibody (haab), igm antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43262","name":"Endo cholangiopancreatograph","description":"Endoscopic retrograde cholangiopancreatography (ercp); with sphincterotomy/papillotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68335","name":"Revise/graft eyelid lining","description":"Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":388.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32664","name":"Thoracoscopy w/ th nrv exc","description":"Thoracoscopy, surgical; with thoracic sympathectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":675.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00144","name":"Anes px eye corneal trnspl","description":"Anesthesia for procedures on eye; corneal transplant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0341","name":"Percutaneous islet celltrans","description":"Percutaneous islet cell transplant, includes portal vein catheterization and infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1300.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73085","name":"Contrast x-ray of elbow","description":"Radiologic examination, elbow, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24101","name":"Arthrt elbw jt expl bx rmvl","description":"Arthrotomy, elbow; with joint exploration, with or without biopsy, with or without removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":420.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86750","name":"Malaria antibody","description":"Antibody; plasmodium (malaria)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33781","name":"Rpr tga rcnstj rpr sbpl obst","description":"Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, jatene type); with repair of subpulmonic obstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60300","name":"Aspir/inj thyroid cyst","description":"Aspiration and/or injection, thyroid cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33779","name":"Rpr tga rcnstj rmvl plm bnd","description":"Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, jatene type); with removal of pulmonary band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2027.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93571","name":"Iv dop vel&/press c flo 1st","description":"Intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, when performed; initial vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86644","name":"Cmv antibody","description":"Antibody; cytomegalovirus (cmv)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37206","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2842.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80424","name":"Glucagon tolerance panel","description":"Glucagon tolerance panel; for pheochromocytoma this panel must include the following: catecholamines, fractionated (82384 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33967","name":"Insert i-aort percut device","description":"Insertion of intra-aortic balloon assist device, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21081","name":"Impres&prep mndbl res prosth","description":"Impression and custom preparation; mandibular resection prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21365","name":"Opn tx complx malar fx","description":"Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51550","name":"Partial removal of bladder","description":"Cystectomy, partial; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":786.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85557","name":"Rbc osmotic fragility","description":"Osmotic fragility, rbc; incubated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33503","name":"Coronary artery graft","description":"Repair of anomalous coronary artery from pulmonary artery origin; by graft, without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82677","name":"Assay of estriol","description":"Estriol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25077","name":"Resect forearm/wrist tum<3cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0826","name":"Pwc gp 2 vhd seat/back","description":"Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28120","name":"Part removal of ankle/heel","description":"Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86706","name":"Hep b surface antibody","description":"Hepatitis b surface antibody (hbsab)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27634","name":"Exc leg/ankle tum dep 5 cm/>","description":"Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27418","name":"Repair degenerated kneecap","description":"Anterior tibial tubercleplasty (eg, maquet type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31051","name":"Sphenoid sinus surgery","description":"Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":498.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96040","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93270","name":"Remote 30 day ecg rev/report","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57200","name":"Repair of vagina","description":"Colporrhaphy, suture of injury of vagina (nonobstetrical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":202.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0327","name":"Colon ca scrn;bld-bsd biomrk","description":"Colorectal cancer screening; blood-based biomarker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34051","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1620","name":"Ho flex pavlik harns pre cst","description":"Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96401","name":"Chemo anti-neopl sq/im","description":"Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82306","name":"Vitamin d 25 hydroxy","description":"Vitamin d; 25 hydroxy, includes fraction(s), if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8042","name":"Orbital prosthesis","description":"Orbital prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1833.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0642","name":"Dynamic standing frame","description":"Standing frame/table system, mobile (dynamic stander), any size including pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93930","name":"Upper extremity study","description":"Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2005","name":"Kafo sng/dbl mechanical act","description":"Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61510","name":"Crnec treph exc brn tum sttl","description":"Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21348","name":"Opn tx nasomax fx w/graft","description":"Open treatment of nasomaxillary complex fracture (lefort ii type); with bone grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":882.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51500","name":"Removal of bladder cyst","description":"Excision of urachal cyst or sinus, with or without umbilical hernia repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":514.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0073T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83880","name":"Assay of natriuretic peptide","description":"Natriuretic peptide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87486","name":"Chlmyd pneum dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); chlamydia pneumoniae, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32097","name":"Open wedge/bx lung nodule","description":"Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82175","name":"Assay of arsenic","description":"Arsenic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93792","name":"Pt/caregiver traing home inr","description":"Patient/caregiver training for initiation of home international normalized ratio (inr) monitoring under the direction of a physician or other qualified health care professional, face-to-face, including use and care of the inr monitor, obtaining blood sample, instructions for reporting home inr test ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63286","name":"Bx/exc idrl imed lesn thrc","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64517","name":"N block inj hypogas plxs","description":"Injection, anesthetic agent; superior hypogastric plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74262","name":"Ct colonography dx w/dye","description":"Computed tomographic (ct) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67903","name":"Repair eyelid defect","description":"Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":363.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7003","name":"Nebulizer administration set","description":"Administration set, with small volume nonfiltered pneumatic nebulizer, disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49255","name":"Removal of omentum","description":"Omentectomy, epiploectomy, resection of omentum (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":643.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01930","name":"Anes ther ivntl rad ven nos","description":"Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0340","name":"Robt lin-radsurg fractx 2-5","description":"Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2012.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92553","name":"Audiometry air & bone","description":"Pure tone audiometry (threshold); air and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41820","name":"Excision gum each quadrant","description":"Gingivectomy, excision gingiva, each quadrant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46610","name":"Anoscopy remove lesion","description":"Anoscopy; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00752","name":"Anes hrna rpr lmbr&vnt&/dehs","description":"Anesthesia for hernia repairs in upper abdomen; lumbar and ventral (incisional) hernias and/or wound dehiscence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12046","name":"Intmd rpr n-hf/genit20.1-30","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87533","name":"Hhv-6 dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); herpes virus-6, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33926","name":"Repr pul art unifocal w/cpb","description":"Repair of pulmonary artery arborization anomalies by unifocalization; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35271","name":"Rpr blvs gr ot/th vn ntrth w","description":"Repair blood vessel with graft other than vein; intrathoracic, with bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92937","name":"Prq trluml revsc cab grf 1","description":"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed, single major coronary artery and/or its branches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":472.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4706","name":"Bicarbonate conc sol per gal","description":"Bicarbonate concentrate, solution, for hemodialysis, per gallon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19357","name":"Tiss xpndr plmt brst rcnstj","description":"Tissue expander placement in breast reconstruction, including subsequent expansion(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61592","name":"Orbitocranial approach/skull","description":"Orbitocranial zygomatic approach to middle cranial fossa (cavernous sinus and carotid artery, clivus, basilar artery or petrous apex) including osteotomy of zygoma, craniotomy, extra- or intradural elevation of temporal lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2863.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92625","name":"Tinnitus assessment","description":"Assessment of tinnitus (includes pitch, loudness matching, and masking)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31572","name":"Largsc w/laser dstrj les","description":"Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":387.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83663","name":"Fluoro polarize fetal lung","description":"Fetal lung maturity assessment; fluorescence polarization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24145","name":"Prtl exc bone radial h/n","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":500.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27654","name":"Repair of achilles tendon","description":"Repair, secondary, achilles tendon, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":585.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90868","name":"Tcranial magn stim tx deli","description":"Therapeutic repetitive transcranial magnetic stimulation (tms) treatment; subsequent delivery and management, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28805","name":"Amputation thru metatarsal","description":"Amputation, foot; transmetatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":592.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12037","name":"Intmd rpr s/tr/ext >30.0 cm","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":313.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83010","name":"Assay of haptoglobin quant","description":"Haptoglobin; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81333","name":"Tgfbi gene common variants","description":"Tgfbi (transforming growth factor beta-induced) (eg, corneal dystrophy) gene analysis, common variants (eg, r124h, r124c, r124l, r555w, r555q)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87511","name":"Gardner vag dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); gardnerella vaginalis, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78580","name":"Lung perfusion imaging","description":"Pulmonary perfusion imaging (eg, particulate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5082","name":"Continent stoma catheter","description":"Continent device; catheter for continent stoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35536","name":"Art byp grft splenorenal","description":"Bypass graft, with vein; splenorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76857","name":"Us exam pelvic limited","description":"Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11624","name":"Exc s/n/h/f/g mal+mrg 3.1-4","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82106","name":"Alpha-fetoprotein amniotic","description":"Alpha-fetoprotein (afp); amniotic fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52007","name":"Cysto urtrl cathj brush bx","description":"Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":382.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38571","name":"Laparoscopy lymphadenectomy","description":"Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82480","name":"Assay serum cholinesterase","description":"Cholinesterase; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0313","name":"Immunize couns < 21yr 6-30 m","description":"Immunization counseling by a physician or other qualified health care professional when  the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time (this code is used for medicaid billing purposes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0973","name":"W/ch access det adj armrest","description":"Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15777","name":"Acellular derm matrix implt","description":"Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54308","name":"Reconstruction of urethra","description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0802","name":"Pov group 1 vhd 451-600 lbs","description":"Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58661","name":"Laparoscopy remove adnexa","description":"Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11471","name":"Exc skn h/p/p/u complex","description":"Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95130","name":"Immntx 1 sting insect","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single stinging insect venom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86481","name":"Tb ag response t-cell susp","description":"Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing t-cells in cell suspension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32100","name":"Exploration of chest","description":"Thoracotomy; with exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86215","name":"Deoxyribonuclease antibody","description":"Deoxyribonuclease, antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50957","name":"Ureter endoscopy & treatment","description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85378","name":"Fibrin degrade semiquant","description":"Fibrin degradation products, d-dimer; qualitative or semiquantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95966","name":"Meg evoked single","description":"Magnetoencephalography (meg), recording and analysis; for evoked magnetic fields, single modality (eg, sensory, motor, language, or visual cortex localization)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1127.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1050","name":"Sternal pad","description":"Addition to ctlso or scoliosis orthosis, sternal pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27759","name":"Treatment of tibia fracture","description":"Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":844.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4427","name":"Ost pch drain/barr lk flng/f","description":"Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5622","name":"Test socket knee disarticula","description":"Addition to lower extremity, test socket, knee disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35363","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; combined aortoiliofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0483","name":"Hi freq chest wall oscil sys","description":"High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68040","name":"Treatment of eyelid lesions","description":"Expression of conjunctival follicles (eg, for trachoma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85004","name":"Automated diff wbc count","description":"Blood count; automated differential wbc count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2202","name":"Seat width 24-27 in","description":"Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61591","name":"Infratemporal approach/skull","description":"Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, infratemporal fossa) including mastoidectomy, resection of sigmoid sinus, with or without decompression and/or mobilization of contents of auditory cana","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2611.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8300","name":"Truss single w/ standard pad","description":"Truss, single with standard pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53520","name":"Repair of urethra defect","description":"Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0044","name":"Ftrst upr hanger brac rep ea","description":"Footrest, upper hanger bracket, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15272","name":"Skin sub graft t/a/l add-on","description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8670","name":"Vascular graft, synthetic","description":"Vascular graft material, synthetic, implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86803","name":"Hepatitis c ab test","description":"Hepatitis c antibody;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61623","name":"Evasc temp balo artl occ h/n","description":"Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiogra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96004","name":"Phys review of motion tests","description":"Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with writ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57520","name":"Conization of cervix","description":"Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":211.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0102T","name":"Esw phy anes lat hmrl epcndl","description":"Extracorporeal shock wave performed by a physician, requiring anesthesia other than local, and involving the lateral humeral epicondyle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55120","name":"Removal of scrotum lesion","description":"Removal of foreign body in scrotum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":285.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27860","name":"Fixation of ankle joint","description":"Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6885","name":"Replc sockt shldr dis/interc","description":"Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0621","name":"Sio flex pelvic/sacr pre ots","description":"Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5711","name":"Knee-shin exo mnl lock ultra","description":"Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32666","name":"Thoracoscopy w/wedge resect","description":"Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63077","name":"Spine disk surgery thorax","description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, single interspace","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76506","name":"Echo exam of head","description":"Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnormalities), including a-mode encephalography as secondary component where indicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75563","name":"Card mri w/stress img & dye","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3100","name":"Hallus-valgus nt dyn pre ots","description":"Hallus-valgus night dynamic splint, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80422","name":"Glucagon tolerance panel","description":"Glucagon tolerance panel; for insulinoma this panel must include the following: glucose (82947 x 3) insulin (83525 x 3)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42426","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0225","name":"Hydrocollator unit","description":"Hydrocollator unit, includes pads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41822","name":"Excision of gum lesion","description":"Excision of fibrous tuberosities, dentoalveolar structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51990","name":"Laparo urethral suspension","description":"Laparoscopy, surgical; urethral suspension for stress incontinence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86694","name":"Herpes simplex nes antbdy","description":"Antibody; herpes simplex, non-specific type test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6310","name":"Shoulder passive restor comp","description":"Shoulder disarticulation, passive restoration (complete prosthesis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G9141","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36227","name":"Place cath xtrnl carotid","description":"Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21742","name":"Repair stern/nuss w/o scope","description":"Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (nuss procedure), without thoracoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":570.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69955","name":"Release facial nerve","description":"Total facial nerve decompression and/or repair (may include graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30310","name":"Remove nasal foreign body","description":"Removal foreign body, intranasal; requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82120","name":"Amines vaginal fluid qual","description":"Amines, vaginal fluid, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93590","name":"Perq transcath cls mitral","description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1043.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19282","name":"Perq device breast ea imag","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92611","name":"Motion fluoroscopy/swallow","description":"Motion fluoroscopic evaluation of swallowing function by cine or video recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19082","name":"Bx breast add lesion strtctc","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99190","name":"Special pump services","description":"Assembly and operation of pump with oxygenator or heat exchanger (with or without ecg and/or pressure monitoring); each hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73725","name":"Mr ang lwr ext w or w/o dye","description":"Magnetic resonance angiography, lower extremity, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35206","name":"Repair blood vessel dir uxtr","description":"Repair blood vessel, direct; upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":679.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3925","name":"Fo pip dip jnt/sprng pre ots","description":"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78606","name":"Brain image w/flow 4 + views","description":"Brain imaging, minimum 4 static views; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72255","name":"Myelography thoracic spine","description":"Myelography, thoracic, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80173","name":"Assay of haloperidol","description":"Haloperidol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28043","name":"Exc foot/toe tum sc < 1.5 cm","description":"Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7009","name":"Nebulizer reservoir bottle","description":"Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0171","name":"Commode chair non-electric","description":"Commode chair with integrated seat lift mechanism, non-electric, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89310","name":"Semen analysis w/count","description":"Semen analysis; motility and count (not including huhner test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99305","name":"1st nf care moderate mdm 35","description":"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 35 minutes must be met or ex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46280","name":"Remove anal fist complex","description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25607","name":"Optx dst rd xartc fx/epi sep","description":"Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60220","name":"Partial removal of thyroid","description":"Total thyroid lobectomy, unilateral; with or without isthmusectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43860","name":"Revj gstr/jj anast w/o vgtmy","description":"Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1364.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33502","name":"Coronary artery correction","description":"Repair of anomalous coronary artery from pulmonary artery origin; by ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1105.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77432","name":"Stereotactic radiation trmt","description":"Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86692","name":"Hepatitis delta agent antbdy","description":"Antibody; hepatitis, delta agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33282","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87280","name":"Respiratory syncytial ag if","description":"Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64874","name":"Repair & revise nerve add-on","description":"Suture of nerve; requiring extensive mobilization, or transposition of nerve (list separately in addition to code for nerve suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47715","name":"Excision of bile duct cyst","description":"Excision of choledochal cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1115.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37228","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2476.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15793","name":"Chemical peel nonfacial drm","description":"Chemical peel, nonfacial; dermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84085","name":"Assay of rbc pg6d enzyme","description":"Phosphogluconate, 6-, dehydrogenase, rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33460","name":"Revision of tricuspid valve","description":"Valvectomy, tricuspid valve, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67343","name":"Release eye tissue","description":"Release of extensive scar tissue without detaching extraocular muscle (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44820","name":"Excision of mesentery lesion","description":"Excision of lesion of mesentery (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":690.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53260","name":"Treatment of urethra lesion","description":"Excision or fulguration; urethral polyp(s), distal urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75573","name":"Ct hrt c+ strux cgen hrt ds","description":"Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3d image postprocessing, assessment of left ventricular [lv] cardiac function, right ventricular [rv] structure and function and evaluation of ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":239.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77423","name":"Neutron beam tx complex","description":"High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2300","name":"Lens sphere trifocal 4.00d","description":"Sphere, trifocal, plano to plus or minus 4.00d, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60521","name":"Removal of thymus gland","description":"Thymectomy, partial or total; sternal split or transthoracic approach, without radical mediastinal dissection (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":970.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95829","name":"Surgery electrocorticogram","description":"Electrocorticogram at surgery (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23397","name":"Muscle transfers","description":"Muscle transfer, any type, shoulder or upper arm; multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":965.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35013","name":"Repair artery rupture arm","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, axillary-brachial artery, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1108.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53515","name":"Repair of urethra injury","description":"Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0433","name":"Portable liquid oxygen sys","description":"Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39541","name":"Repair of diaphragm hernia","description":"Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27380","name":"Repair of kneecap tendon","description":"Suture of infrapatellar tendon; primary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20245","name":"Bone biopsy open deep","description":"Biopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46922","name":"Excision of anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85049","name":"Automated platelet count","description":"Blood count; platelet, automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88174","name":"Cytopath c/v auto in fluid","description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39501","name":"Repair diaphragm laceration","description":"Repair, laceration of diaphragm, any approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87045","name":"Feces culture aerobic bact","description":"Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, kia, lia), salmonella and shigella species","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96413","name":"Chemo iv infusion 1 hr","description":"Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2610","name":"Hip clevis/thrust bearing lo","description":"Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6198","name":"Alginate dressing > 48 sq in","description":"Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51715","name":"Endoscopic injection/implant","description":"Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":277.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36516","name":"Apheresis immunoads slctv","description":"Therapeutic apheresis; with extracorporeal immunoadsorption, selective adsorption or selective filtration and plasma reinfusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1579.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33262","name":"Rmvl& replc pulse gen 1 lead","description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":321.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01996","name":"Dly hosp mgmt edrl rx admin","description":"Daily hospital management of epidural or subarachnoid continuous drug administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95824","name":"Eeg cerebral death only","description":"Electroencephalogram (eeg); cerebral death evaluation only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11721","name":"Debride nail 6 or more","description":"Debridement of nail(s) by any method(s); 6 or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64630","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent; pudendal nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65710","name":"Corneal transplant","description":"Keratoplasty (corneal transplant); anterior lamellar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33508","name":"Endoscopic vein harvest","description":"Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0733","name":"12-24hr sealed lead acid","description":"Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11719","name":"Trim nail(s) any number","description":"Trimming of nondystrophic nails, any number","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58146","name":"Myomectomy abdom complex","description":"Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g, abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":742.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0069","name":"Rr whl compl sol tire rep ea","description":"Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9612","name":"Catheterize for urine spec","description":"Catheterization for collection of specimen, single patient, all places of service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99151","name":"Mod sed same phys/qhp <5 yrs","description":"Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6259","name":"Transparent film > 48 sq in","description":"Transparent film, sterile, more than 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29823","name":"Sho arthrs srg xtnsv dbrdmt","description":"Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the ro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":527.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73010","name":"X-ray exam of shoulder blade","description":"Radiologic examination; scapula, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63020","name":"Lamot dcmprn nrv rt 1 cerv","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0342","name":"Laparoscopy islet cell trans","description":"Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11720","name":"Debride nail 1-5","description":"Debridement of nail(s) by any method(s); 1 to 5","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85244","name":"Clot factor viii reltd antgn","description":"Clotting; factor viii related antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4207","name":"2 cc sterile syringe&needle","description":"Syringe with needle, sterile 2 cc, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40520","name":"Partial excision of lip","description":"Excision of lip; v-excision with primary direct linear closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45900","name":"Reduction of rectal prolapse","description":"Reduction of procidentia (separate procedure) under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45347","name":"Sigmoidoscopy w/plcmt stent","description":"Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83030","name":"Hemoglobin f fetal chemical","description":"Hemoglobin; f (fetal), chemical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93797","name":"Phys/qhp op car rhab wo ecg","description":"Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ecg monitoring (per session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21010","name":"Incision of jaw joint","description":"Arthrotomy, temporomandibular joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61253","name":"Burr hole treph ittl uni/bi","description":"Burr hole(s) or trephine, infratentorial, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":902.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27500","name":"Treatment of thigh fracture","description":"Closed treatment of femoral shaft fracture, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78075","name":"Adrenal cortex & medulla img","description":"Adrenal imaging, cortex and/or medulla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00170","name":"Anes intraoral px nos","description":"Anesthesia for intraoral procedures, including biopsy; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0443","name":"Brief alcohol misuse counsel","description":"Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61519","name":"Remove brain lining lesion","description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2719.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96167","name":"Hlth bhv ivntj fam 1st 30","description":"Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47630","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":405.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30220","name":"Insert nasal septal button","description":"Insertion, nasal septal prosthesis (button)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":228.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4384","name":"Ostomy faceplt/silicone ring","description":"Ostomy faceplate equivalent, silicone ring, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61680","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; supratentorial, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4480","name":"Vabra aspirator","description":"Vabra aspirator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22800","name":"Arthrd pst dfrm<6 vrt sgm","description":"Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1186.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83065","name":"Hemoglobin thermolabile","description":"Hemoglobin; thermolabile","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0188","name":"Synthetic sheepskin pad","description":"Synthetic sheepskin pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6197","name":"Alginate drsg >16 <=48 sq in","description":"Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9502","name":"Tc99m tetrofosmin","description":"Technetium tc-99m tetrofosmin, diagnostic, per study dose","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0517T","name":"Insj wcs lv both compnt pg","description":"Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; both components of pulse generator (battery and transmitter) only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2208","name":"Cylinder tank carrier","description":"Wheelchair accessory, cylinder tank carrier, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21445","name":"Optx mndblr/max alv ridge fx","description":"Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93581","name":"Transcath closure of vsd","description":"Percutaneous transcatheter closure of a congenital ventricular septal defect with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1422.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27727","name":"Repair of lower leg","description":"Repair of congenital pseudarthrosis, tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5506","name":"Diabetic shoe w/off set heel","description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93971","name":"Extremity study","description":"Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19030","name":"Njx px only mam ducto/glcto","description":"Injection procedure only for mammary ductogram or galactogram","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72133","name":"Ct lumbar spine w/o & w/dye","description":"Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76816","name":"Ob us follow-up per fetus","description":"Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87811","name":"Sars-cov-2 covid19 w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01120","name":"Anes px on bony pelvis","description":"Anesthesia for procedures on bony pelvis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87536","name":"Hiv-1 quant&revrse trnscrpj","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-1, quantification, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23040","name":"Arthrt gh jt expl/drg/rmv fb","description":"Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":604.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47721","name":"Fuse upper gi structures","description":"Cholecystoenterostomy; with gastroenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72200","name":"X-ray exam si joints","description":"Radiologic examination, sacroiliac joints; less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73650","name":"X-ray exam of heel","description":"Radiologic examination; calcaneus, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49505","name":"Prp i/hern init reduc >5 yr","description":"Repair initial inguinal hernia, age 5 years or older; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":433.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58952","name":"Resect ovarian malignancy","description":"Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with radical dissection for debulking (ie, radical excision or destruction, intra-abdominal or retroperitoneal tumors)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21620","name":"Ostectomy sternum partial","description":"Ostectomy of sternum, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86741","name":"Neisseria meningitidis","description":"Antibody; neisseria meningitidis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4350","name":"Ankle control ortho pre ots","description":"Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85032","name":"Manual cell count each","description":"Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2397","name":"Pwc acc, lith-based battery","description":"Power wheelchair accessory, lithium-based battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5636","name":"Symes type medial opening so","description":"Addition to lower extremity, symes type, medial opening socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31636","name":"Bronchoscopy bronch stents","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":162.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6010","name":"Part hand little/ring","description":"Partial hand, little and/or ring finger remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72295","name":"X-ray of lower spine disk","description":"Discography, lumbar, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37218","name":"Stent placemt ante carotid","description":"Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":709.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15936","name":"Exc sac pr ulc prep mus flap","description":"Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24371","name":"Revise reconst elbow joint","description":"Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1504.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25526","name":"Optx rdl shft fx&dstl rad/ul","description":"Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (galeazzi fracture/ dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27266","name":"Treat hip dislocation","description":"Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32667","name":"Thoracoscopy w/w resect addl","description":"Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93602","name":"Intra-atrial recording","description":"Intra-atrial recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76948","name":"Echo guide ova aspiration","description":"Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2325","name":"Sip and puff interface","description":"Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28111","name":"Part removal of metatarsal","description":"Ostectomy, complete excision; first metatarsal head","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31502","name":"Change of windpipe airway","description":"Tracheotomy tube change prior to establishment of fistula tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54055","name":"Destruction penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69000","name":"Drg xtrnl ear absc/hem smpl","description":"Drainage external ear, abscess or hematoma; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15261","name":"Fth/gft fr n/e/e/l each addl","description":"Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86580","name":"Tb intradermal test","description":"Skin test; tuberculosis, intradermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58548","name":"Lap radical hyst","description":"Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1194.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64489","name":"Tap block bi by infusion","description":"Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) bilateral; by continuous infusions (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":224.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63702","name":"Repair of spinal herniation","description":"Repair of meningocele; larger than 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2501","name":"Cntct lens pmma-toric/prism","description":"Contact lens, pmma, toric or prism ballast, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21431","name":"Cltx craniofacial separation","description":"Closed treatment of craniofacial separation (lefort iii type) using interdental wire fixation of denture or splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":554.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77021","name":"Mri guidance ndl plmt rs&i","description":"Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6456","name":"Zinc paste band w >=3in<5in/yd","description":"Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32480","name":"Partial removal of lung","description":"Removal of lung, other than pneumonectomy; single lobe (lobectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1182.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01770","name":"Anes px art upr arm&elbw nos","description":"Anesthesia for procedures on arteries of upper arm and elbow; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95864","name":"Needle emg 4 extremities","description":"Needle electromyography; 4 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26135","name":"Revise finger joint each","description":"Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86160","name":"Complement antigen","description":"Complement; antigen, each component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81186","name":"Cacna1a gen known famil vrnt","description":"Cacna1a (calcium voltage-gated channel subunit alpha1 a) (eg, spinocerebellar ataxia) gene analysis; known familial variant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72240","name":"Myelography neck spine","description":"Myelography, cervical, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77074","name":"Radex osseous survey lmtd","description":"Radiologic examination, osseous survey; limited (eg, for metastases)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11604","name":"Exc tr-ext mal+marg 3.1-4 cm","description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6216","name":"Non-sterile gauze<=16 sq in","description":"Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76941","name":"Echo guide for transfusion","description":"Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6024","name":"Collagen dsg wound filler","description":"Collagen dressing wound filler, sterile, per 6 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33425","name":"Repair of mitral valve","description":"Valvuloplasty, mitral valve, with cardiopulmonary bypass;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61050","name":"Remove brain canal fluid","description":"Cisternal or lateral cervical (c1-c2) puncture; without injection (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36583","name":"Replace tunneled cv cath","description":"Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1042.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8688","name":"Implt nrostm pls gen dua non","description":"Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92341","name":"Fit spectacles bifocal","description":"Fitting of spectacles, except for aphakia; bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58672","name":"Laparoscopy fimbrioplasty","description":"Laparoscopy, surgical; with fimbrioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87530","name":"Hsv dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); herpes simplex virus, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61550","name":"Release of skull seams","description":"Craniectomy for craniosynostosis; single cranial suture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1075.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92120","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0444T","name":"1st plmt drug elut oc ins","description":"Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28465","name":"Optx tarsal bone fx each","description":"Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":517.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66983","name":"Cataract surg w/iol 1 stage","description":"Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35621","name":"Bpg axillary-femoral","description":"Bypass graft, with other than vein; axillary-femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":966.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46742","name":"Repair of imperforated anus","description":"Repair of high imperforate anus with rectourethral or rectovaginal fistula; combined transabdominal and sacroperineal approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2086.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4197","name":"Parenteral sol 74-100 gm pro","description":"Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65771","name":"Radial keratotomy","description":"Radial keratotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":241.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88375","name":"Optical endomicroscpy interp","description":"Optical endomicroscopic image(s), interpretation and report, real-time or referred, each endoscopic session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42400","name":"Biopsy of salivary gland","description":"Biopsy of salivary gland; needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43882","name":"Rev/rmvl gstr nstim eltrd","description":"Revision or removal of gastric neurostimulator electrodes, antrum, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27194","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":577.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49550","name":"Rpr rem hernia init reduce","description":"Repair initial femoral hernia, any age; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4408","name":"Ext wear ost skn barr >4sqin","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25630","name":"Cltx carpl fx w/o mnpj ea b1","description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74740","name":"X-ray female genital tract","description":"Hysterosalpingography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91111","name":"Gi trc img intral esophagus","description":"Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5822","name":"Endo knee-shin pneum swg frc","description":"Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1047.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2500","name":"Sgd digitized pre-rec <=8min","description":"Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73719","name":"Mri lower extremity w/dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35201","name":"Repair blood vessel dir neck","description":"Repair blood vessel, direct; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":820.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27070","name":"Part remove hip bone super","description":"Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23545","name":"Cltx acromclav dislc w/mnpj","description":"Closed treatment of acromioclavicular dislocation; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43320","name":"Fuse esophagus & stomach","description":"Esophagogastrostomy (cardioplasty), with or without vagotomy and pyloroplasty, transabdominal or transthoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82626","name":"Dehydroepiandrosterone","description":"Dehydroepiandrosterone (dhea)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71045","name":"X-ray exam chest 1 view","description":"Radiologic examination, chest; single view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2215","name":"Lens lenticular bifocal","description":"Lenticular (myodisc), per lens, bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28054","name":"Biopsy of toe joint lining","description":"Arthrotomy with biopsy; interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93770","name":"Determination venous press","description":"Determination of venous pressure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25426","name":"Repair/graft radius & ulna","description":"Repair of defect with autograft; radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":951.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8900","name":"Mra w/cont, abd","description":"Magnetic resonance angiography with contrast, abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0193","name":"Powered air flotation bed","description":"Powered air flotation bed (low air loss therapy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78580","name":"Lung perfusion imaging","description":"Pulmonary perfusion imaging (eg, particulate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":191.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73521","name":"X-ray exam hips bi 2 views","description":"Radiologic examination, hips, bilateral, with pelvis when performed; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33959","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57700","name":"Revision of cervix","description":"Cerclage of uterine cervix, nonobstetrical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36861","name":"Cannula declotting","description":"External cannula declotting (separate procedure); with balloon catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3580","name":"O shoe add instep velcro clo","description":"Orthopedic shoe addition, convert instep to velcro closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01942","name":"Anes neuromd/ntrvrt lmbr/sac","description":"Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0185","name":"Gel pressure mattress pad","description":"Gel or gel-like pressure pad for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00539","name":"Anes tracheobronchial rcnstj","description":"Anesthesia for tracheobronchial reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4390","name":"Drainable pch ex wear convex","description":"Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2340","name":"Pre-tibial shell molded to p","description":"Addition to lower extremity, pre-tibial shell, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0288","name":"Recon, cta for surg plan","description":"Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50972","name":"Ureter endoscopy & catheter","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86833","name":"Hla class ii high defin qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), hla class ii","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1295","name":"Wheelchair heavy duty fixed","description":"Heavy duty wheelchair, fixed full length arms, elevating legrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32482","name":"Bilobectomy","description":"Removal of lung, other than pneumonectomy; 2 lobes (bilobectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1267.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37252","name":"Intrvasc us noncoronary 1st","description":"Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43847","name":"Gstr rstcv px sm int rcnstj","description":"Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82154","name":"Androstanediol glucuronide","description":"Androstanediol glucuronide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55842","name":"Extensive prostate surgery","description":"Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy(s) (limited pelvic lymphadenectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":948.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76978","name":"Us trgt dyn mbubb 1st les","description":"Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67107","name":"Repair detached retina","description":"Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), including, when performed, implant, cryotherapy, photocoagulation, and drainage of subretinal fluid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":677.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77054","name":"X-ray of mammary ducts","description":"Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78015","name":"Thyroid met imaging","description":"Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88164","name":"Cytopath tbs c/v manual","description":"Cytopathology, slides, cervical or vaginal (the bethesda system); manual screening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9502","name":"Tc99m tetrofosmin","description":"Technetium tc-99m tetrofosmin, diagnostic, per study dose","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69620","name":"Myringoplasty","description":"Myringoplasty (surgery confined to drumhead and donor area)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93287","name":"Peri-px device eval & prgr","description":"Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22116","name":"Remove extra spine segment","description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57421","name":"Exam/biopsy of vag w/scope","description":"Colposcopy of the entire vagina, with cervix if present; with biopsy(s) of vagina/cervix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0852","name":"Pwc gp 3 vhd seat/back","description":"Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25065","name":"Biopsy forearm soft tissues","description":"Biopsy, soft tissue of forearm and/or wrist; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74261","name":"Ct colonography dx","description":"Computed tomographic (ct) colonography, diagnostic, including image postprocessing; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5629","name":"Below knee acrylic socket","description":"Addition to lower extremity, below knee, acrylic socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":210.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83698","name":"Assay lipoprotein pla2","description":"Lipoprotein-associated phospholipase a2 (lp-pla2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47620","name":"Removal of gallbladder","description":"Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1155.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L2770","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32554","name":"Aspirate pleura w/o imaging","description":"Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":164.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93592","name":"Perq transcath closure each","description":"Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35646","name":"Bpg aortobifemoral","description":"Bypass graft, with other than vein; aortobifemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70549","name":"Mr angiograph neck w/o&w/dye","description":"Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82331","name":"Calcium infusion test","description":"Calcium; after calcium infusion test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6446","name":"Conform band s w>=3in <5in/yd","description":"Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0849","name":"Pwc gp 3 std cap chair","description":"Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35081","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87164","name":"Dark field exam spec collj","description":"Dark field examination, any source (eg, penile, vaginal, oral, skin); includes specimen collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36260","name":"Insertion of infusion pump","description":"Insertion of implantable intra-arterial infusion pump (eg, for chemotherapy of liver)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":567.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73110","name":"X-ray exam of wrist","description":"Radiologic examination, wrist; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33212","name":"Insert pulse gen sngl lead","description":"Insertion of pacemaker pulse generator only; with existing single lead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6586","name":"Elbow fair lead cable dir fo","description":"Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":934.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58260","name":"Vaginal hysterectomy","description":"Vaginal hysterectomy, for uterus 250 g or less;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92354","name":"Fitg spect low vis 1system","description":"Fitting of spectacle mounted low vision aid; single element system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5822","name":"Endo knee-shin pneum swg frc","description":"Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2220","name":"Dorsi & plantar flex ass/res","description":"Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00630","name":"Anes px lumbar region nos","description":"Anesthesia for procedures in lumbar region; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27516","name":"Treat thigh fx growth plate","description":"Closed treatment of distal femoral epiphyseal separation; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61607","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0172","name":"Cerv col sr foam 2pc pre ots","description":"Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96415","name":"Chemo iv infusion addl hr","description":"Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4334","name":"Urinary cath leg strap","description":"Urinary catheter anchoring device, leg strap, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2010","name":"Remot image submit by pt","description":"Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m ser","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38205","name":"Harvest allogeneic stem cell","description":"Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92284","name":"Dx dark adaptation exam i&r","description":"Diagnostic dark adaptation examination (eg, rod and cone sensitivities, rod-cone breakpoint), with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2083","name":"Visit esketamine, > 56m","description":"Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of  greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":673.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81165","name":"Brca1 gene full seq alys","description":"Brca1 (brca1, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21275","name":"Revision orbitofacial bones","description":"Secondary revision of orbitocraniofacial reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":706.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85291","name":"Clot factor xiii fibrin scrn","description":"Clotting; factor xiii (fibrin stabilizing), screen solubility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88153","name":"Cytopath c/v redo","description":"Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99442","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78110","name":"Plasma volume single","description":"Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28062","name":"Removal of foot fascia","description":"Fasciectomy, plantar fascia; radical (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4399","name":"Ostomy irrig cone/cath w brs","description":"Ostomy irrigation supply; cone/catheter, with or without brush","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70492","name":"Ct sft tsue nck w/o & w/dye","description":"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87811","name":"Sars-cov-2 covid19 w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78456","name":"Acute venous thrombus image","description":"Acute venous thrombosis imaging, peptide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38745","name":"Remove armpit lymph nodes","description":"Axillary lymphadenectomy; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":588.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56637","name":"Vlvctmy rad comp bi lymphad","description":"Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9507","name":"In111 capromab","description":"Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":792.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38525","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, deep axillary node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38770","name":"Remove pelvis lymph nodes","description":"Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":508.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43282","name":"Lap paraesoph her rpr w/mesh","description":"Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01930","name":"Anes ther ivntl rad ven nos","description":"Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99204","name":"Office o/p new mod 45 min","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 45 minutes must be met or excee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48554","name":"Transpl allograft pancreas","description":"Transplantation of pancreatic allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2120.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26863","name":"Fuse/graft added joint","description":"Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft), each additional joint (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70350","name":"X-ray head for orthodontia","description":"Cephalogram, orthodontic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75625","name":"Contrast exam abdominl aorta","description":"Aortography, abdominal, by serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74445","name":"X-ray exam of penis","description":"Corpora cavernosography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26551","name":"Great toe-hand transfer","description":"Transfer, toe-to-hand with microvascular anastomosis; great toe wrap-around with bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26145","name":"Tendon excision palm/finger","description":"Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":429.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53444","name":"Insert tandem cuff","description":"Insertion of tandem cuff (dual cuff)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0995","name":"Wc calf rest, pad replacemnt","description":"Wheelchair accessory, calf rest/pad, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94453","name":"Hast w/suppl oxygen titrj","description":"High altitude simulation test (hast), with interpretation and report by a physician or other qualified health care professional; with supplemental oxygen titration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50740","name":"Fusion of ureter & kidney","description":"Ureteropyelostomy, anastomosis of ureter and renal pelvis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72132","name":"Ct lumbar spine w/dye","description":"Computed tomography, lumbar spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46730","name":"Construction of absent anus","description":"Repair of high imperforate anus without fistula; perineal or sacroperineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1647.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84478","name":"Assay of triglycerides","description":"Triglycerides","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26820","name":"Thumb fusion with graft","description":"Fusion in opposition, thumb, with autogenous graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94618","name":"Pulmonary stress testing","description":"Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0480","name":"Tlso rigid plastic custom fa","description":"Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, res","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49441","name":"Place duod/jej tube perc","description":"Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":818.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43216","name":"Esophagoscopy lesion removal","description":"Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":302.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26591","name":"Repair muscles of hand","description":"Repair, intrinsic muscles of hand, each muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36225","name":"Place cath subclavian art","description":"Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24116","name":"Exc/crtg b1 cst/tum hum algr","description":"Excision or curettage of bone cyst or benign tumor, humerus; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4714","name":"Treated water per gallon","description":"Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1950","name":"Afo spiral molded to pt plas","description":"Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":462.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2603","name":"Skin protect wc cus wd <22in","description":"Skin protection wheelchair seat cushion, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90868","name":"Tcranial magn stim tx deli","description":"Therapeutic repetitive transcranial magnetic stimulation (tms) treatment; subsequent delivery and management, per session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0038","name":"Leg strap each","description":"Leg strap, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29881","name":"Arthrs kne srg mnisectmy m/l","description":"Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":454.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85004","name":"Automated diff wbc count","description":"Blood count; automated differential wbc count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54163","name":"Repair of circumcision","description":"Repair incomplete circumcision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81183","name":"Atxn10 gene detc abnor allel","description":"Atxn10 (ataxin 10) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24495","name":"Decompression fasct forearm","description":"Decompression fasciotomy, forearm, with brachial artery exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":680.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63304","name":"Remove vert idrl body crvcl","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2154.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87592","name":"N.gonorrhoeae dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); neisseria gonorrhoeae, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15935","name":"Exc sac pr ulc skn flp ostc","description":"Excision, sacral pressure ulcer, with skin flap closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":740.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62180","name":"Establish brain cavity shunt","description":"Ventriculocisternostomy (torkildsen type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1461.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39545","name":"Revision of diaphragm","description":"Imbrication of diaphragm for eventration, transthoracic or transabdominal, paralytic or nonparalytic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":771.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2371","name":"Gr27 sealed leadacid battery","description":"Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67430","name":"Explore/treat eye socket","description":"Orbitotomy with bone flap or window, lateral approach (eg, kroenlein); with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31730","name":"Intro windpipe wire/tube","description":"Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87040","name":"Blood culture for bacteria","description":"Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93660","name":"Tilt table evaluation","description":"Evaluation of cardiovascular function with tilt table evaluation, with continuous ecg monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8510","name":"Voice amplifier","description":"Voice amplifier","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":123.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27093","name":"Injection for hip x-ray","description":"Injection procedure for hip arthrography; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82380","name":"Assay of carotene","description":"Carotene","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15120","name":"Splt agrft f/s/n/h/f/g/m 1st","description":"Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":537.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27365","name":"Resect femur/knee tumor","description":"Radical resection of tumor, femur or knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1752.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0179","name":"Md recertification hha pt","description":"Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77412","name":"Radiation tx delivery lvl 3","description":"Radiation treatment delivery; level 3, multiple isocenters with photon therapy (eg, 2d, 3d, or imrt) or a single-isocenter photon therapy (eg, 3d or imrt) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88323","name":"Consltj&reprt matrl prep sld","description":"Consultation and report on referred material requiring preparation of slides","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62361","name":"Implant spine infusion pump","description":"Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43180","name":"Esophagoscopy rigid trnso","description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, zenkers diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":425.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61582","name":"Craniofacial approach skull","description":"Craniofacial approach to anterior cranial fossa; extradural, including unilateral or bifrontal craniotomy, elevation of frontal lobe(s), osteotomy of base of anterior cranial fossa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2757.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81178","name":"Atxn1 gene detc abnor allele","description":"Atxn1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58541","name":"Lsh uterus 250 g or less","description":"Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":464.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28238","name":"Revision of foot tendon","description":"Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, kidner type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54162","name":"Lysis penil circumic lesion","description":"Lysis or excision of penile post-circumcision adhesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34846","name":"Visc & infraren abd 2 prosth","description":"Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1920.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64772","name":"Incision of spinal nerve","description":"Transection or avulsion of other spinal nerve, extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":474.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7003","name":"Nebulizer administration set","description":"Administration set, with small volume nonfiltered pneumatic nebulizer, disposable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29035","name":"Appl body cast sho to hips","description":"Application of body cast, shoulder to hips;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":205.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64450","name":"Njx aa&/strd other pn/branch","description":"Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54050","name":"Destruction penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67560","name":"Revise eye socket implant","description":"Orbital implant (implant outside muscle cone); removal or revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":635.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78140","name":"Red cell sequestration","description":"Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88323","name":"Consltj&reprt matrl prep sld","description":"Consultation and report on referred material requiring preparation of slides","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99477","name":"Init day hosp neonate care","description":"Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6205","name":"Composite drsg > 48 sq in","description":"Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27654","name":"Repair of achilles tendon","description":"Repair, secondary, achilles tendon, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62256","name":"Remove brain cavity shunt","description":"Removal of complete cerebrospinal fluid shunt system; without replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":541.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5611","name":"Ak 4 bar link w/fric swing","description":"Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27284","name":"Arthrodesis hip joint","description":"Arthrodesis, hip joint (including obtaining graft);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1368.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84260","name":"Assay of serotonin","description":"Serotonin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01360","name":"Anes open px lower 1/3 femur","description":"Anesthesia for all open procedures on lower one-third of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95976","name":"Alys smpl cn npgt prgrmg","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86880","name":"Coombs test direct","description":"Antihuman globulin test (coombs test); direct, each antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29405","name":"Appl short leg cast","description":"Application of short leg cast (below knee to toes);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63268","name":"Excise intrspinl lesion scrl","description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; sacral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78586","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65130","name":"Insert ocular implant","description":"Insertion of ocular implant secondary; after evisceration, in scleral shell","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88121","name":"Cytp urine 3-5 probes cmptr","description":"Cytopathology, in situ hybridization (eg, fish), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0457","name":"Tlso flex trnk sj-ss pre ots","description":"Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on t","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":486.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82962","name":"Glucose blood test","description":"Glucose, blood by glucose monitoring device(s) cleared by the fda specifically for home use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11420","name":"Exc h-f-nk-sp b9+marg 0.5/<","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31577","name":"Largsc w/rmvl foreign bdy(s)","description":"Laryngoscopy, flexible; with removal of foreign body(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0615","name":"Pacemaker monitr digital/vis","description":"Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38230","name":"Bone marrow harvest allogen","description":"Bone marrow harvesting for transplantation; allogeneic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":133.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0319","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94667","name":"Mnpj chest wall 1st","description":"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0147","name":"Scr c/v cyto, automated sys","description":"Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74270","name":"X-ray xm colon 1cntrst std","description":"Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1940","name":"Afo molded to patient plasti","description":"Ankle foot orthosis, plastic or other material, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":292.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78223","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33957","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0166","name":"Extrnl counterpulse, per tx","description":"External counterpulsation, per treatment session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19380","name":"Revj reconstructed breast","description":"Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":500.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2112","name":"Afo tibial fracture soft","description":"Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00174","name":"Anes ntrorl exc rtrphrng tum","description":"Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78300","name":"Bone imaging limited area","description":"Bone and/or joint imaging; limited area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54520","name":"Removal of testis","description":"Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74245","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0976","name":"Lso full corset","description":"Lso, full corset","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62355","name":"Remove spinal canal catheter","description":"Removal of previously implanted intrathecal or epidural catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":229.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27535","name":"Treat knee fracture","description":"Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":760.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01444","name":"Anes px art knee&pop exc&grf","description":"Anesthesia for procedures on arteries of knee and popliteal area; popliteal excision and graft or repair for occlusion or aneurysm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00924","name":"Anes male gent undscnd tstis","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); undescended testis, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4216","name":"Sterile water/saline, 10 ml","description":"Sterile water, saline and/or dextrose, diluent/flush, 10 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99291","name":"Critical care first hour","description":"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15823","name":"Blepharp upr eyelid xcsv skn","description":"Blepharoplasty, upper eyelid; with excessive skin weighting down lid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":373.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61619","name":"Repair dura","description":"Secondary repair of dura for cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by local or regionalized vascularized pedicle flap or myocutaneous flap (including galea, temporalis, frontalis or occipitalis muscle)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1212.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61570","name":"Remove foreign body brain","description":"Craniectomy or craniotomy; with excision of foreign body from brain","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1709.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69200","name":"Clear outer ear canal","description":"Removal foreign body from external auditory canal; without general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0294","name":"Hosp bed semi-elect w/ mattr","description":"Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57420","name":"Exam of vagina w/scope","description":"Colposcopy of the entire vagina, with cervix if present;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74363","name":"X-ray bile duct dilation","description":"Percutaneous transhepatic dilation of biliary duct stricture with or without placement of stent, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76883","name":"Us nrv&acc strux 1xtr compre","description":"Ultrasound, nerve(s) and accompanying structures throughout their entire anatomic course in one extremity, comprehensive, including real-time cine imaging with image documentation, per extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19300","name":"Mastectomy for gynecomastia","description":"Mastectomy for gynecomastia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":356.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28570","name":"Treat foot dislocation","description":"Closed treatment of talotarsal joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86602","name":"Antinomyces antibody","description":"Antibody; actinomyces","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77051","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27502","name":"Treatment of thigh fracture","description":"Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85210","name":"Clot factor ii prothrom spec","description":"Clotting; factor ii, prothrombin, specific","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89125","name":"Specimen fat stain","description":"Fat stain, feces, urine, or respiratory secretions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44401","name":"Colonoscopy with ablation","description":"Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64495","name":"Inj paravert f jnt l/s 3 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), lumbar or sacral; third and any additional level(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83662","name":"Foam stability fetal lung","description":"Fetal lung maturity assessment; foam stability test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93460","name":"R&l hrt art/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68020","name":"Incise/drain eyelid lining","description":"Incision of conjunctiva, drainage of cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29705","name":"Rmvl/bivlv full arm/leg cast","description":"Removal or bivalving; full arm or full leg cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0055T","name":"Bone srgry cmptr ct/mri imag","description":"Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on ct/mri images (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88342","name":"Imhchem/imcytchm 1st antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53420","name":"Reconstruct urethra stage 1","description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":680.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93270","name":"Remote 30 day ecg rev/report","description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27766","name":"Optx medial ankle fx","description":"Open treatment of medial malleolus fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62164","name":"Remove brain tumor w/scope","description":"Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74190","name":"Peritoneogram rs&i","description":"Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30300","name":"Remove nasal foreign body","description":"Removal foreign body, intranasal; office type procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95886","name":"Musc test done w/n test comp","description":"Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (list separately in addition to code for ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0274","name":"Over-bed table","description":"Over-bed table","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20805","name":"Replant forearm complete","description":"Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33240","name":"Insrt pulse gen w/singl lead","description":"Insertion of implantable defibrillator pulse generator only; with existing single lead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93655","name":"Icar cath abltj dscrt arrhyt","description":"Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26320","name":"Removal of implant from hand","description":"Removal of implant from finger or hand","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77321","name":"Special teletx port plan","description":"Special teletherapy port plan, particles, hemibody, total body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15361","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2214","name":"Init/sub psych care m 1st 30","description":"Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51585","name":"Removal of bladder & nodes","description":"Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1706.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65285","name":"Repair of eye wound","description":"Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49656","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":765.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54205","name":"Njx px peyronie ds exps plaq","description":"Injection procedure for peyronie disease; with surgical exposure of plaque","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65272","name":"Repair of eye wound","description":"Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64681","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":468.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87290","name":"Varicella zoster ag if","description":"Infectious agent antigen detection by immunofluorescent technique; varicella zoster virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4070","name":"Replace prox & dist upright","description":"Replace proximal and distal upright for kafo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0116","name":"Crutch underarm each no wood","description":"Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8427","name":"Ready gradient glove","description":"Gradient pressure aid (glove), ready made","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01925","name":"Anes ivntl rad artl crtd/c","description":"Anesthesia for therapeutic interventional radiological procedures involving the arterial system; carotid or coronary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23174","name":"Sqstrctmy humrl head srg nck","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":640.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77054","name":"X-ray of mammary ducts","description":"Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33315","name":"Exploratory heart surgery","description":"Cardiotomy, exploratory (includes removal of foreign body, atrial or ventricular thrombus); with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75889","name":"Vein x-ray liver w/hemodynam","description":"Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86920","name":"Compatibility test spin","description":"Compatibility test each unit; immediate spin technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17274","name":"Dstr mal les s/n/h/f/g 3.1-4","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4419","name":"Ost pch for bar w flange/flt","description":"Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43400","name":"Ligate esophagus veins","description":"Ligation, direct, esophageal varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1277.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20982","name":"Ablate bone tumor(s) perq","description":"Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6239","name":"Hydrocolld drg > 48 in w/bdr","description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93922","name":"Upr/l xtremity art 2 levels","description":"Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, doppler waveform recording and analysis at 1-2 levels, or ankle/brachial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32110","name":"Explore/repair chest","description":"Thoracotomy; with control of traumatic hemorrhage and/or repair of lung tear","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17360","name":"Chemical exfoliation acne","description":"Chemical exfoliation for acne (eg, acne paste, acid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11044","name":"Dbrdmt bone 1st 20 sq cm/<","description":"Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49062","name":"Drain to peritoneal cavity","description":"Drainage of extraperitoneal lymphocele to peritoneal cavity, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":642.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0092","name":"Set up port xray equipment","description":"Set-up portable x-ray equipment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98980","name":"Rtm tx mgmt 1st 20 min","description":"Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; first 20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23462","name":"Repair shoulder capsule","description":"Capsulorrhaphy, anterior, any type; with coracoid process transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":905.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15221","name":"Fth/gft fr s/a/l each addl","description":"Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29848","name":"Wrist endoscopy/surgery","description":"Endoscopy, wrist, surgical, with release of transverse carpal ligament","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27465","name":"Shortening of thigh bone","description":"Osteoplasty, femur; shortening (excluding 64876)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1061.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77371","name":"Srs multisource","description":"Radiation treatment delivery, stereotactic radiosurgery (srs), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source cobalt 60 based","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":866.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83009","name":"H pylori (c-13) blood","description":"Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope (eg, c-13)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0444","name":"Portable 02 contents, liquid","description":"Portable oxygen contents, liquid, 1 months supply = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47420","name":"Incision of bile duct","description":"Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; without transduodenal sphincterotomy or sphincteroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22804","name":"Arthrd pst dfrm 13+ vrt sgm","description":"Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67218","name":"Treatment of retinal lesion","description":"Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; radiation by implantation of source (includes removal of source)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86762","name":"Rubella antibody","description":"Antibody; rubella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50547","name":"Laparo removal donor kidney","description":"Laparoscopy, surgical; donor nephrectomy (including cold preservation), from living donor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1381.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26765","name":"Treat finger fracture each","description":"Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0891","name":"Pwc gp5 ped mult pow opt s/b","description":"Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35011","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, axillary-brachial artery, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33234","name":"Removal of pacemaker system","description":"Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22305","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54056","name":"Cryosurgery penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2202","name":"Seat width 24-27 in","description":"Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54231","name":"Dynamic cavernosometry","description":"Dynamic cavernosometry, including intracavernosal injection of vasoactive drugs (eg, papaverine, phentolamine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26531","name":"Revise knuckle with implant","description":"Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84126","name":"Assay of feces porphyrins","description":"Porphyrins, feces, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20205","name":"Deep muscle biopsy","description":"Biopsy, muscle; deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0840","name":"Pwc gp2 xhd sing pow opt s/b","description":"Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44955","name":"Appendectomy add-on","description":"Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E8002","name":"Anterior gait trainer","description":"Gait trainer, pediatric size, anterior support, includes all accessories and components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2312","name":"Mini-prop remote joystick","description":"Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11010","name":"Debride skin at fx site","description":"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissues","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19350","name":"Nipple/areola reconstruction","description":"Nipple/areola reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":529.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78459","name":"Myocrd img pet single study","description":"Myocardial imaging, positron emission tomography (pet), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50948","name":"Laparo new ureter/bladder","description":"Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1030.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21338","name":"Open nasoethmoid fx w/o fixj","description":"Open treatment of nasoethmoid fracture; without external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":532.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4630","name":"Repl bat t.e.n.s. own by pt","description":"Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87283","name":"Rubeola ag if","description":"Infectious agent antigen detection by immunofluorescent technique; rubeola","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28153","name":"Partial removal of toe","description":"Resection, condyle(s), distal end of phalanx, each toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27825","name":"Treat lower leg fracture","description":"Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61616","name":"Resect/excise lesion skull","description":"Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or c1-c3 vertebral bodies; intradural, including dural repair, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62100","name":"Repair brain fluid leakage","description":"Craniotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26113","name":"Exc hand tum deep 1.5 cm/>","description":"Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); 1.5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99244","name":"Off/op cnsltj new/est mod 40","description":"Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63707","name":"Repair spinal fluid leakage","description":"Repair of dural/cerebrospinal fluid leak, not requiring laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":821.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61708","name":"Revise circulation to head","description":"Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial electrothrombosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27698","name":"Repair of ankle ligament","description":"Repair, secondary, disrupted ligament, ankle, collateral (eg, watson-jones procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28296","name":"Cor hlx vlgs dstl mtar osteo","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30620","name":"Intranasal reconstruction","description":"Septal or other intranasal dermatoplasty (does not include obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44160","name":"Removal of colon","description":"Colectomy, partial, with removal of terminal ileum with ileocolostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01650","name":"Anes art sho&ax nos","description":"Anesthesia for procedures on arteries of shoulder and axilla; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50562","name":"Renal scope w/tumor resect","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with resection of tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37609","name":"Ligation/bx temporal artery","description":"Ligation or biopsy, temporal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30115","name":"Removal of nose polyp(s)","description":"Excision, nasal polyp(s), extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37215","name":"Transcath stent cca w/eps","description":"Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15851","name":"Removal sutr/staple req anes","description":"Removal of sutures or staples requiring anesthesia (ie, general anesthesia, moderate sedation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88344","name":"Imhchem/imcytchm ea mlt antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27652","name":"Repair/graft achilles tendon","description":"Repair, primary, open or percutaneous, ruptured achilles tendon; with graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":539.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0509T","name":"Pattern erg w/i&r","description":"Electroretinography (erg) with interpretation and report, pattern (perg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27570","name":"Fixation of knee joint","description":"Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":126.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61544","name":"Remove & treat brain lesion","description":"Craniotomy with elevation of bone flap; for excision or coagulation of choroid plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1741.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42810","name":"Excision of neck cyst","description":"Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":298.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93978","name":"Vascular study","description":"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84478","name":"Assay of triglycerides","description":"Triglycerides","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23150","name":"Removal of humerus lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal humerus;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":562.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87073","name":"Culture bacteria anaerobic","description":"Culture, bacterial; quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82310","name":"Assay of calcium","description":"Calcium; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59840","name":"Induced abortion d&c","description":"Induced abortion, by dilation and curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36216","name":"Place catheter in artery","description":"Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92627","name":"Eval aud funcj ea addl 15","description":"Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59070","name":"Transabdom amnioinfus w/us","description":"Transabdominal amnioinfusion, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87338","name":"Hpylori stool ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; helicobacter pylori, stool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47780","name":"Fuse bile ducts and bowel","description":"Anastomosis, roux-en-y, of extrahepatic biliary ducts and gastrointestinal tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2069.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2219","name":"Foam caster tire any size ea","description":"Manual wheelchair accessory, foam caster tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37247","name":"Trluml balo angiop addl art","description":"Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":361.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11005","name":"Dbrdmt skin abdominal wall","description":"Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":524.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5812","name":"Endo knee-shin frct swg & st","description":"Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26449","name":"Release forearm/hand tendon","description":"Tenolysis, complex, extensor tendon, finger, including forearm, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96902","name":"Mcrscp xm hair pluck/clipped","description":"Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to determine telogen and anagen counts, or structural hair shaft abnormality","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72285","name":"Discography cerv/thor spine","description":"Discography, cervical or thoracic, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3150","name":"Abduct rotation bar w/o shoe","description":"Foot, abduction rotation bar, without shoes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7039","name":"Filter, non disposable w pap","description":"Filter, non disposable, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"ATP10","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70380","name":"X-ray exam of salivary gland","description":"Radiologic examination, salivary gland for calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76975","name":"Gi endoscopic ultrasound","description":"Gastrointestinal endoscopic ultrasound, supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27137","name":"Revise hip joint replacement","description":"Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6242","name":"Hydrogel drg <=16 in w/o bdr","description":"Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69222","name":"Clean out mastoid cavity","description":"Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94750","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4722","name":"Dialys sol fld vol > 1999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33949","name":"Ecmo/ecls daily mgmt artery","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; daily management, each day, veno-arterial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75705","name":"Artery x-rays spine","description":"Angiography, spinal, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21933","name":"Exc back tum deep 5 cm/>","description":"Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":635.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95907","name":"Nvr cndj tst 1-2 studies","description":"Nerve conduction studies; 1-2 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90957","name":"Esrd srv 4 vsts p mo 12-19","description":"End-stage renal disease (esrd) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93315","name":"Echo transesophageal","description":"Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5855","name":"Mech hip extension assist","description":"Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27156","name":"Revision of hip bones","description":"Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy and with open reduction of hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84478","name":"Assay of triglycerides","description":"Triglycerides","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61550","name":"Release of skull seams","description":"Craniectomy for craniosynostosis; single cranial suture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26358","name":"Repair/graft hand tendon","description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no mans land); secondary, with free graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":828.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75574","name":"Ct angio hrt w/3d image","description":"Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3d image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28262","name":"Revision of foot and ankle","description":"Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot deformity)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4206","name":"1 cc sterile syringe&needle","description":"Syringe with needle, sterile, 1 cc or less, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01234","name":"Anes opn upr 2/3 fem rad res","description":"Anesthesia for open procedures involving upper two-thirds of femur; radical resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4385","name":"Ost skn barrier sld ext wear","description":"Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22901","name":"Exc abdl tum deep 5 cm/>","description":"Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77031","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3912","name":"Hfo flexion glove pre ots","description":"Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27760","name":"Cltx medial ankle fx","description":"Closed treatment of medial malleolus fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19318","name":"Breast reduction","description":"Breast reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85008","name":"Bl smear w/o diff wbc count","description":"Blood count; blood smear, microscopic examination without manual differential wbc count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58263","name":"Vag hyst w/t/o & vag repair","description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":638.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36223","name":"Place cath carotid/inom art","description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27592","name":"Amputate leg at thigh","description":"Amputation, thigh, through femur, any level; open, circular (guillotine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0342","name":"Laparoscopy islet cell trans","description":"Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":412.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27105","name":"Transfer of spinal muscle","description":"Transfer paraspinal muscle to hip (includes fascial or tendon extension graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0198","name":"Water pressure pad for mattr","description":"Water pressure pad for mattress, standard mattress length and width","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26180","name":"Removal of finger tendon","description":"Excision of tendon, finger, flexor or extensor, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":370.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0450","name":"Tlso flex trunk/thor pre ots","description":"Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3201","name":"Oxford w supinat/pronat inf","description":"Orthopedic shoe, oxford with supinator or pronator, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43350","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":908.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84480","name":"Assay triiodothyronine (t3)","description":"Triiodothyronine t3; total (tt-3)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29856","name":"Tibial arthroscopy/surgery","description":"Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes internal fixation, when performed (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85307","name":"Assay activated protein c","description":"Activated protein c (apc) resistance assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62225","name":"Replace/irrigate catheter","description":"Replacement or irrigation, ventricular catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75722","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93458","name":"L hrt artery/ventricle angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82131","name":"Amino acids single quant","description":"Amino acids; single, quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0497","name":"Bat clps elec/comb vad, rep","description":"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":228.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59000","name":"Amniocentesis diagnostic","description":"Amniocentesis; diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74290","name":"Contrast x-ray gallbladder","description":"Cholecystography, oral contrast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76390","name":"Mr spectroscopy","description":"Magnetic resonance spectroscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":337.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87300","name":"Ag detection polyval if","description":"Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50690","name":"Injection for ureter x-ray","description":"Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21268","name":"Revise eye sockets","description":"Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; combined intra- and extracranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1702.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76821","name":"Middle cerebral artery echo","description":"Doppler velocimetry, fetal; middle cerebral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87621","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0632","name":"Lso sag rigid frame cust","description":"Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":633.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77082","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0484","name":"Non-elec oscillatory pep dvc","description":"Oscillatory positive expiratory pressure device, non-electric, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26587","name":"Reconstruct extra finger","description":"Reconstruction of polydactylous digit, soft tissue and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":879.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0396","name":"Alcohol/subs interv 15-30mn","description":"Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29906","name":"Subtalar arthro w/deb","description":"Arthroscopy, subtalar joint, surgical; with debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":549.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88313","name":"Special stains group 2","description":"Special stain including interpretation and report; group ii, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95957","name":"Eeg digital analysis","description":"Digital analysis of electroencephalogram (eeg) (eg, for epileptic spike analysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25073","name":"Exc forearm tum deep 3 cm/>","description":"Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":451.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49419","name":"Insert tun ip cath w/port","description":"Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":347.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9552","name":"F18 fdg","description":"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87428","name":"Sarscov & inf vir a&b ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, sars-cov, s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26540","name":"Repair hand joint","description":"Repair of collateral ligament, metacarpophalangeal or interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5585","name":"Prep ak ischial open end","description":"Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59121","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":718.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99397","name":"Per pm reeval est pat 65+ yr","description":"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 ye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11105","name":"Punch bx skin ea sep/addl","description":"Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92071","name":"Contact lens fitting for tx","description":"Fitting of contact lens for treatment of ocular surface disease","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92555","name":"Speech threshold audiometry","description":"Speech audiometry threshold;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21182","name":"Reconstruct cranial bone","description":"Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting less than 40 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15004","name":"Wound prep f/n/hf/g","description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of bo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27880","name":"Amputation of lower leg","description":"Amputation, leg, through tibia and fibula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":788.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86320","name":"Serum immunoelectrophoresis","description":"Immunoelectrophoresis; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0490","name":"Emr pwr source elec vad, rep","description":"Emergency power source for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25535","name":"Cltx ulnar shft fx w/mnpj","description":"Closed treatment of ulnar shaft fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97016","name":"Vasopneumatic device therapy","description":"Application of a modality to 1 or more areas; vasopneumatic devices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87265","name":"Pertussis ag if","description":"Infectious agent antigen detection by immunofluorescent technique; bordetella pertussis/parapertussis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1760","name":"Closure dev, vasc","description":"Closure device, vascular (implantable/insertable)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":357.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61642","name":"Dilat ic vspsm ea diff ter","description":"Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0283","name":"Elec stim other than wound","description":"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96902","name":"Mcrscp xm hair pluck/clipped","description":"Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to determine telogen and anagen counts, or structural hair shaft abnormality","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88161","name":"Cytopath smear other source","description":"Cytopathology, smears, any other source; preparation, screening and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58800","name":"Drainage of ovarian cyst(s)","description":"Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7510","name":"Prosthetic device repair rep","description":"Repair of prosthetic device, repair or replace minor parts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33990","name":"Insj perq vad l hrt arterial","description":"Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34201","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":903.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49204","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1245.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27397","name":"Transplants of thigh tendons","description":"Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":773.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75989","name":"Abscess drainage under x-ray","description":"Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49617","name":"Rpr aa hrn rcr > 10 rdc","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":706.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0462","name":"Tlso 3mod sacro-scap pre","description":"Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":607.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38794","name":"Access thoracic lymph duct","description":"Cannulation, thoracic duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27556","name":"Treat knee dislocation","description":"Open treatment of knee dislocation, includes internal fixation, when performed; without primary ligamentous repair or augmentation/reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":744.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01215","name":"Anes opn revj tot hip arthrp","description":"Anesthesia for open procedures involving hip joint; revision of total hip arthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53620","name":"Dilate urethra stricture","description":"Dilation of urethral stricture by passage of filiform and follower, male; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":118.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65286","name":"Repair of eye wound","description":"Repair of laceration; application of tissue glue, wounds of cornea and/or sclera","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90476","name":"Adenovirus vaccine type 4","description":"Adenovirus vaccine, type 4, live, for oral use","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41005","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74713","name":"Mri fetal ea addl gestation","description":"Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20662","name":"Application halo pelvic","description":"Application of halo, including removal; pelvic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51925","name":"Hysterectomy/bladder repair","description":"Closure of vesicouterine fistula; with hysterectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":883.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93568","name":"Njx car cth nslc p-art angrp","description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1030","name":"W/c vent tray gimbaled","description":"Wheelchair accessory, ventilator tray, gimbaled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8265","name":"Haberman feeder","description":"Haberman feeder for cleft lip/palate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36215","name":"Place catheter in artery","description":"Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":873.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94681","name":"O2 uptk co2 outp % o2 xtrc","description":"Oxygen uptake, expired gas analysis; including co2 output, percentage oxygen extracted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0828","name":"Pwc gp 2 xtra hd seat/back","description":"Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21086","name":"Impres&prep auricular prosth","description":"Impression and custom preparation; auricular prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66984","name":"Xcapsl ctrc rmvl w/o ecp","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":523.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24340","name":"Tenodesis biceps tdn at elbw","description":"Tenodesis of biceps tendon at elbow (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15401","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85460","name":"Hemoglobin fetal","description":"Hemoglobin or rbcs, fetal, for fetomaternal hemorrhage; differential lysis (kleihauer-betke)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33993","name":"Reposg perq r/l hrt vad","description":"Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5400","name":"Postop dress & 1 cast chg bk","description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":597.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61151","name":"Burr hole/treph sbsq tapping","description":"Burr hole(s) or trephine; with subsequent tapping (aspiration) of intracranial abscess or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10080","name":"I&d pilonidal cyst simple","description":"Incision and drainage of pilonidal cyst; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1037","name":"Transport chair, ped size","description":"Transport chair, pediatric size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61540","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, without electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31525","name":"Dx laryngoscopy excl nb","description":"Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":187.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30802","name":"Ablate inf turbinate submuc","description":"Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5816","name":"Endo knee-shin polyc mch sta","description":"Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":422.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24358","name":"Repair elbow w/deb open","description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfers elbow); debridement, soft tissue and/or bone, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":440.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6570","name":"Scap thorac prosth tiss shap","description":"Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9489","name":"Remote e/m est. pt 40mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision makin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87207","name":"Smear special stain","description":"Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46611","name":"Anoscopy","description":"Anoscopy; with removal of single tumor, polyp, or other lesion by snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36660","name":"Insertion catheter artery","description":"Catheterization, umbilical artery, newborn, for diagnosis or therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5971","name":"Sach foot, replacement","description":"All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42215","name":"Reconstruct cleft palate","description":"Palatoplasty for cleft palate; major revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":570.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29450","name":"Application clubfoot cast","description":"Application of clubfoot cast with molding or manipulation, long or short leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0740","name":"Non-implant pelv flr e-stim","description":"Non-implanted pelvic floor electrical stimulator, complete system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47760","name":"Fuse bile ducts and bowel","description":"Anastomosis, of extrahepatic biliary ducts and gastrointestinal tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36450","name":"Bld exchange truj newborn","description":"Exchange transfusion, blood; newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94770","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44120","name":"Removal of small intestine","description":"Enterectomy, resection of small intestine; single resection and anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1018.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23405","name":"Incision of tendon & muscle","description":"Tenotomy, shoulder area; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15920","name":"Exc coccygl pr ulc prim sutr","description":"Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49572","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67805","name":"Remove eyelid lesions","description":"Excision of chalazion; multiple, different lids","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5200","name":"Kne sing axis fric shin sach","description":"Above knee, molded socket, single axis constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1640.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50405","name":"Revision of kidney/ureter","description":"Pyeloplasty (foley y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64742","name":"Incision of facial nerve","description":"Transection or avulsion of; facial nerve, differential or complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25909","name":"Amputation follow-up surgery","description":"Amputation, forearm, through radius and ulna; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31553","name":"Laryngoplasty laryngeal sten","description":"Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74330","name":"X-ray bile/panc endoscopy","description":"Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97755","name":"Assistive technology assess","description":"Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6721","name":"Hook/hand, hvy dty, vol open","description":"Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1145.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01180","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32553","name":"Ins mark thor for rt perq","description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91034","name":"Gastroesophageal reflux test","description":"Esophagus, gastroesophageal reflux test; with nasal catheter ph electrode(s) placement, recording, analysis and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67343","name":"Release eye tissue","description":"Release of extensive scar tissue without detaching extraocular muscle (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":395.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5508","name":"Diabetic deluxe shoe","description":"For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33470","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1073.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46746","name":"Repair of cloacal anomaly","description":"Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3278.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27330","name":"Biopsy knee joint lining","description":"Arthrotomy, knee; with synovial biopsy only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22812","name":"Arthrd ant dfrm 8+ vrt sgm","description":"Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46505","name":"Chemodenervation anal musc","description":"Chemodenervation of internal anal sphincter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31611","name":"Constj trachesophgl fstl","description":"Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (eg, voice button, blom-singer prosthesis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":397.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44320","name":"Colostomy","description":"Colostomy or skin level cecostomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":989.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66830","name":"Removal of lens lesion","description":"Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":425.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36571","name":"Insert picvad cath","description":"Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28173","name":"Resect metatarsal tumor","description":"Radical resection of tumor; metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43253","name":"Egd us transmural injxn/mark","description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duoden","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23145","name":"Removal of bone lesion","description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32486","name":"Sleeve lobectomy","description":"Removal of lung, other than pneumonectomy; with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1887.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0079","name":"Care manag h vst new pt 60 m","description":"Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69642","name":"Revise middle ear & mastoid","description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36555","name":"Insert non-tunnel cv cath","description":"Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35190","name":"Repair acq av fistula xtr","description":"Repair, acquired or traumatic arteriovenous fistula; extremities","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":666.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33236","name":"Remove electrode/thoracotomy","description":"Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":672.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45119","name":"Remove rectum w/reservoir","description":"Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, j-pouch), with diverting enterostomy when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93456","name":"R hrt coronary artery angio","description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62162","name":"Remove colloid cyst w/scope","description":"Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9979","name":"Remote e/m new pt 20mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: an expanded problem focused history;  an expanded problem focused e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35681","name":"Composite byp grft pros&vein","description":"Bypass graft; composite, prosthetic and vein (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24515","name":"Optx humrl shft fx plate/scr","description":"Open treatment of humeral shaft fracture with plate/screws, with or without cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":740.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21083","name":"Impres&prep paltl lft prosth","description":"Impression and custom preparation; palatal lift prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1120.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43310","name":"Repair of esophagus","description":"Esophagoplasty (plastic repair or reconstruction), thoracic approach; without repair of tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97606","name":"Neg prs wnd ther dme>50 sqcm","description":"Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (dme), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25126","name":"Remove/graft forearm lesion","description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11402","name":"Exc tr-ext b9+marg 1.1-2 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51585","name":"Removal of bladder & nodes","description":"Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29126","name":"Appl short arm splint dyn","description":"Application of short arm splint (forearm to hand); dynamic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1180","name":"Wheelchair amputee w/ foot r","description":"Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33677","name":"Cl mult vsd w/rem pul band","description":"Closure of multiple ventricular septal defects; with removal of pulmonary artery band, with or without gusset","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1830.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38765","name":"Remove groin lymph nodes","description":"Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":855.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0705","name":"Transfer device","description":"Transfer device, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4556","name":"Electrodes, pair","description":"Electrodes, (e.g., apnea monitor), per pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88371","name":"Protein western blot tissue","description":"Protein analysis of tissue by western blot, with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2840","name":"Tibial length sock fx or equ","description":"Addition to lower extremity orthosis, tibial length sock, fracture or equal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2020","name":"Kafo dbl solid stirrup band/","description":"Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar ak orthosis), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81306","name":"Nudt15 gene common variants","description":"Nudt15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common variant(s) (eg, *2, *3, *4, *5, *6)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78315","name":"Bone imaging 3 phase","description":"Bone and/or joint imaging; 3 phase study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0281","name":"Elec stim unattend for press","description":"Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21141","name":"Rcnstj midface lefort i 1pc","description":"Reconstruction midface, lefort i; single piece, segment movement in any direction (eg, for long face syndrome), without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73030","name":"X-ray exam of shoulder","description":"Radiologic examination, shoulder; complete, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57415","name":"Remove vaginal foreign body","description":"Removal of impacted vaginal foreign body (separate procedure) under anesthesia (other than local)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":107.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0619","name":"Apnea monitor w recorder","description":"Apnea monitor, with recording feature","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87910","name":"Nfct agt gntyp alys cmv","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); cytomegalovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31652","name":"Bronch ebus samplng 1/2 node","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":815.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92562","name":"Loudness balance test","description":"Loudness balance test, alternate binaural or monaural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64718","name":"Revise ulnar nerve at elbow","description":"Neuroplasty and/or transposition; ulnar nerve at elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58750","name":"Repair oviduct","description":"Tubotubal anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83500","name":"Assay free hydroxyproline","description":"Hydroxyproline; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4331","name":"Extension drainage tubing","description":"Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84703","name":"Chorionic gonadotropin assay","description":"Gonadotropin, chorionic (hcg); qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96020","name":"Functional brain mapping","description":"Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3923","name":"Hfo without joints pre cst","description":"Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76700","name":"Us exam abdom complete","description":"Ultrasound, abdominal, real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":97.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67710","name":"Severing tarsorrhaphy","description":"Severing of tarsorrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78596","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":320.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33273","name":"Repos prev impltbl subq dfb","description":"Repositioning of previously implanted subcutaneous implantable defibrillator electrode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":345.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64494","name":"Inj paravert f jnt l/s 2 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), lumbar or sacral; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20245","name":"Bone biopsy open deep","description":"Biopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82941","name":"Assay of gastrin","description":"Gastrin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86353","name":"Lymphocyte transformation","description":"Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87552","name":"Mycobacteria dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria species, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A6543","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60500","name":"Explore parathyroid glands","description":"Parathyroidectomy or exploration of parathyroid(s);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":824.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61253","name":"Burr hole treph ittl uni/bi","description":"Burr hole(s) or trephine, infratentorial, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3962","name":"Sewho erbs palsey design abd","description":"Shoulder elbow wrist hand orthosis, abduction positioning, erbs palsey design, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86654","name":"Encephaltis west eqne antbdy","description":"Antibody; encephalitis, western equine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90875","name":"Psychophysiological therapy","description":"Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33958","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3720","name":"Forearm/arm cuffs free motio","description":"Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26641","name":"Treat thumb dislocation","description":"Closed treatment of carpometacarpal dislocation, thumb, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76946","name":"Echo guide for amniocentesis","description":"Ultrasonic guidance for amniocentesis, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92506","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32501","name":"Repair bronchus add-on","description":"Resection and repair of portion of bronchus (bronchoplasty) when performed at time of lobectomy or segmentectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88112","name":"Cytopath cell enhance tech","description":"Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99452","name":"Ntrprof ph1/ntrnet/ehr rfrl","description":"Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38720","name":"Removal of lymph nodes neck","description":"Cervical lymphadenectomy (complete)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75825","name":"Vein x-ray trunk","description":"Venography, caval, inferior, with serialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54322","name":"Reconstruction of urethra","description":"1-stage distal hypospadias repair (with or without chordee or circumcision); with simple meatal advancement (eg, magpi, v-flap)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":633.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8047","name":"Nasal septal prosthesis","description":"Nasal septal prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","KM","95","93","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67916","name":"Repair eyelid defect","description":"Repair of ectropion; excision tarsal wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7035","name":"Pos airway press headgear","description":"Headgear used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33472","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1118.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29440","name":"Adding walker to prev cast","description":"Adding walker to previously applied cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73225","name":"Mr angio upr extr w/o&w/dye","description":"Magnetic resonance angiography, upper extremity, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72052","name":"X-ray exam neck spine 6/>vws","description":"Radiologic examination, spine, cervical; 6 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26715","name":"Treat knuckle dislocation","description":"Open treatment of metacarpophalangeal dislocation, single, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":476.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35876","name":"Removal of clot in graft","description":"Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula); with revision of arterial or venous graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":831.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G2066","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74175","name":"Cta abdomen w/contrast","description":"Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26205","name":"Remove/graft bone lesion","description":"Excision or curettage of bone cyst or benign tumor of metacarpal; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":509.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00622","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37187","name":"Venous mech thrombectomy","description":"Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3440","name":"Heel leather reinforced","description":"Heel, counter, leather reinforced","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82952","name":"Gtt-added samples","description":"Glucose; tolerance test, each additional beyond 3 specimens (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92974","name":"Cath place cardio brachytx","description":"Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96405","name":"Chemo intralesional up to 7","description":"Chemotherapy administration; intralesional, up to and including 7 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15950","name":"Exc trchntr pr ulc prim sutr","description":"Excision, trochanteric pressure ulcer, with primary suture;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":398.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0130","name":"Flex thermoplastic collar mo","description":"Cervical, flexible, thermoplastic collar, molded to patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94780","name":"Cars/bd tst inft-12mo 60 min","description":"Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95961","name":"Electrode stimulation brain","description":"Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":208.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7008","name":"Disposable nebulizer prefill","description":"Large volume nebulizer, disposable, prefilled, used with aerosol compressor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0822","name":"Pwc gp 2 std seat/back","description":"Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36825","name":"Artery-vein autograft","description":"Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92556","name":"Speech audiometry complete","description":"Speech audiometry threshold; with speech recognition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99318","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78120","name":"Red cell mass single","description":"Red cell volume determination (separate procedure); single sampling","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0785","name":"Replacement impl pump cathet","description":"Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86771","name":"Shigella antibody","description":"Antibody; shigella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64451","name":"Njx aa&/strd nrv nrvtg si jt","description":"Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":168.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97016","name":"Vasopneumatic device therapy","description":"Application of a modality to 1 or more areas; vasopneumatic devices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15845","name":"Skin and muscle repair face","description":"Graft for facial nerve paralysis; regional muscle transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":625.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53431","name":"Reconstruct urethra/bladder","description":"Urethroplasty with tubularization of posterior urethra and/or lower bladder for incontinence (eg, tenago, leadbetter procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84403","name":"Assay of total testosterone","description":"Testosterone; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5120","name":"Skin barrier, wipe or swab","description":"Skin barrier, wipes or swabs, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","AU","AV","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74320","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4614","name":"Hand-held pefr meter","description":"Peak expiratory flow rate meter, hand held","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82760","name":"Assay of galactose","description":"Galactose","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66030","name":"Injection treatment of eye","description":"Injection, anterior chamber of eye (separate procedure); medication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0188","name":"Synthetic sheepskin pad","description":"Synthetic sheepskin pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0503T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4364","name":"Adhesive, liquid or equal","description":"Adhesive, liquid or equal, any type, per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96409","name":"Chemo iv push sngl drug","description":"Chemotherapy administration; intravenous, push technique, single or initial substance/drug","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9981","name":"Remote e/m new pt 45mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33415","name":"Revision subvalvular tissue","description":"Resection or incision of subvalvular tissue for discrete subvalvular aortic stenosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1758.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63015","name":"Remove spine lamina >2 crvcl","description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1335.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31238","name":"Nsl/sins ndsc srg nsl hemrrg","description":"Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":186.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31259","name":"Nsl/sins ndsc sphn tiss rmvl","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21600","name":"Partial removal of rib","description":"Excision of rib, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92230","name":"Fluorescein angioscopy i&r","description":"Fluorescein angioscopy with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44603","name":"Suture small intestine","description":"Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; multiple perforations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1341.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93613","name":"Intracardiac ephys 3d mapg","description":"Intracardiac electrophysiologic 3-dimensional mapping (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8680","name":"Implt neurostim elctr each","description":"Implantable neurostimulator electrode, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45315","name":"Proctosigmoidoscopy removal","description":"Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57155","name":"Insert uteri tandem/ovoids","description":"Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62320","name":"Njx interlaminar crv/thrc","description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78016","name":"Thyroid met imaging/studies","description":"Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19285","name":"Perq dev breast 1st us imag","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99485","name":"Suprv interfacilty transport","description":"Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data inter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93232","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2523","name":"Cntct lens hydrophil extend","description":"Contact lens, hydrophilic, extended wear, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13100","name":"Cmplx rpr trunk 1.1-2.5 cm","description":"Repair, complex, trunk; 1.1 cm to 2.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":211.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43870","name":"Closure gastrostomy surgical","description":"Closure of gastrostomy, surgical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":588.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49400","name":"Air injection into abdomen","description":"Injection of air or contrast into peritoneal cavity (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53500","name":"Urethrlys transvag w/ scope","description":"Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0492","name":"Emr pwr cbl elec vad, rep","description":"Emergency power supply cable for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0836","name":"Pwc gp2 std sing pow opt cap","description":"Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82286","name":"Assay of bradykinin","description":"Bradykinin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15150","name":"Tis cltr skn agrft t/a/l 1st","description":"Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93612","name":"Intraventricular pacing","description":"Intraventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25526","name":"Optx rdl shft fx&dstl rad/ul","description":"Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (galeazzi fracture/ dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":806.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87420","name":"Resp syncytial virus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90468","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26496","name":"Revise thumb tendon","description":"Opponensplasty; other methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":719.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4481","name":"Tracheostoma filter","description":"Tracheostoma filter, any type, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01610","name":"Anes all px nrv musc sho&ax","description":"Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77305","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76604","name":"Us exam chest","description":"Ultrasound, chest (includes mediastinum), real time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26541","name":"Repair hand joint with graft","description":"Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":675.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43237","name":"Endoscopic us exam esoph","description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83014","name":"H pylori drug admin","description":"Helicobacter pylori; drug administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92558","name":"Evoked auditory test qual","description":"Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3001","name":"Foot insert remov molded spe","description":"Foot, insert, removable, molded to patient model, spenco, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86606","name":"Aspergillus antibody","description":"Antibody; aspergillus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83937","name":"Assay of osteocalcin","description":"Osteocalcin (bone g1a protein)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96127","name":"Brief emotional/behav assmt","description":"Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [adhd] scale), with scoring and documentation, per standardized instrument","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95957","name":"Eeg digital analysis","description":"Digital analysis of electroencephalogram (eeg) (eg, for epileptic spike analysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27390","name":"Incision of thigh tendon","description":"Tenotomy, open, hamstring, knee to hip; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93351","name":"Stress tte complete","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4558","name":"Conductive gel or paste","description":"Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69120","name":"Removal of external ear","description":"Excision external ear; complete amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93784","name":"Ambl bp mntr w/software","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; including recording, scanning analysis, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70134","name":"X-ray exam of middle ear","description":"Radiologic examination, internal auditory meati, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87471","name":"Bartonella dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); bartonella henselae and bartonella quintana, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87430","name":"Strep a ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; streptococcus, group a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78075","name":"Adrenal cortex & medulla img","description":"Adrenal imaging, cortex and/or medulla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":364.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43360","name":"Gastrointestinal repair","description":"Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with stomach, with or without pyloroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1867.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67915","name":"Repair eyelid defect","description":"Repair of ectropion; thermocauterization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8514","name":"Repl trach puncture dilator","description":"Tracheoesophageal puncture dilator, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64620","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, intercostal nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96521","name":"Refill/maint portable pump","description":"Refilling and maintenance of portable pump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85245","name":"Clot factor viii vw ristoctn","description":"Clotting; factor viii, vw factor, ristocetin cofactor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50970","name":"Ureter endoscopy","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64820","name":"Sympathectomy digital artery","description":"Sympathectomy; digital arteries, each digit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8470","name":"Pros sock single ply bk","description":"Prosthetic sock, single ply, fitting, below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62117","name":"Reduction of skull defect","description":"Reduction of craniomegalic skull (eg, treated hydrocephalus); requiring craniotomy and reconstruction with or without bone graft (includes obtaining grafts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1801.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70559","name":"Mri brain w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15830","name":"Exc excessive skin abdomen","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":762.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77413","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93616","name":"Esophageal recording w/pacg","description":"Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7006","name":"Filtered nebulizer admin set","description":"Administration set, with small volume filtered pneumatic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27605","name":"Incision of achilles tendon","description":"Tenotomy, percutaneous, achilles tendon (separate procedure); local anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93503","name":"Insert/place heart catheter","description":"Insertion and placement of flow directed catheter (eg, swan-ganz) for monitoring purposes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36470","name":"Njx sclrsnt 1 incmptnt vein","description":"Injection of sclerosant; single incompetent vein (other than telangiectasia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68100","name":"Biopsy conjunctiva","description":"Biopsy of conjunctiva","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0450","name":"Tlso flex trunk/thor pre ots","description":"Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0306","name":"Cbc/diffwbc w/o platelet","description":"Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96570","name":"Photodynmc tx 30 min add-on","description":"Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes (list separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59072","name":"Umbilical cord occlud w/us","description":"Fetal umbilical cord occlusion, including ultrasound guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84135","name":"Assay of pregnanediol","description":"Pregnanediol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00800","name":"Anes px lwr ant abdl wal nos","description":"Anesthesia for procedures on lower anterior abdominal wall; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88262","name":"Chromosome analysis 15-20","description":"Chromosome analysis; count 15-20 cells, 2 karyotypes, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0290T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70134","name":"X-ray exam of middle ear","description":"Radiologic examination, internal auditory meati, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52353","name":"Cystouretero w/lithotripsy","description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0141","name":"Rigid wheeled walker adj/fix","description":"Walker, rigid, wheeled, adjustable or fixed height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50520","name":"Close kidney-skin fistula","description":"Closure of nephrocutaneous or pyelocutaneous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1015.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27826","name":"Treat lower leg fracture","description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":711.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82075","name":"Assay of breath ethanol","description":"Alcohol (ethanol); breath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75557","name":"Cardiac mri for morph","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13121","name":"Cmplx rpr s/a/l 2.6-7.5 cm","description":"Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01170","name":"Anes opn px symph pub/si jt","description":"Anesthesia for open procedures involving symphysis pubis or sacroiliac joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11047","name":"Dbrdmt bone each addl","description":"Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65125","name":"Revise ocular implant","description":"Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60520","name":"Removal of thymus gland","description":"Thymectomy, partial or total; transcervical approach (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":908.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00914","name":"Anes trurl px rescj prst8","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of prostate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51792","name":"Urinary reflex study","description":"Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96156","name":"Hlth bhv assmt/reassessment","description":"Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84112","name":"Eval amniotic fluid protein","description":"Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (eg, placental alpha microglobulin-1 [pamg-1], placental protein 12 [pp12], alpha-fetoprotein), qualitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54416","name":"Remv/repl penis contain pros","description":"Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56632","name":"Vlvctmy rad prtl bi lymphad","description":"Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":890.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92015","name":"Determine refractive state","description":"Determination of refractive state","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00873","name":"Anes lithotrp esw wo wtr bth","description":"Anesthesia for lithotripsy, extracorporeal shock wave; without water bath","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69421","name":"Incision of eardrum","description":"Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21198","name":"Reconstr lwr jaw segment","description":"Osteotomy, mandible, segmental;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":900.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5530","name":"Prep bk ptb thermopls molded","description":"Preparatory, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38241","name":"Transplt autol hct/donor","description":"Hematopoietic progenitor cell (hpc); autologous transplantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0980","name":"Wheelchair safety vest","description":"Safety vest, wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99339","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78496","name":"Heart first pass add-on","description":"Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87541","name":"Legion pneumo dna amp prob","description":"Infectious agent detection by nucleic acid (dna or rna); legionella pneumophila, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59857","name":"Induced ab 1+vag supp hyst","description":"Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed medical evacuation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":514.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58950","name":"Resect ovarian malignancy","description":"Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":723.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0165","name":"Commode chair with detacharm","description":"Commode chair, mobile or stationary, with detachable arms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2086","name":"Off base opioid tx 70min","description":"Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":235.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5818","name":"Endo knee-shin frct swg & st","description":"Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27470","name":"Repair of thigh","description":"Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg, compression technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":997.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73610","name":"X-ray exam of ankle","description":"Radiologic examination, ankle; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99407","name":"Behav chng smoking > 10 min","description":"Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74248","name":"X-ray sm int f-thru std","description":"Radiologic small intestine follow-through study, including multiple serial images (list separately in addition to code for primary procedure for upper gi radiologic examination)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00670","name":"Anes xtnsv sp&spi cord px","description":"Anesthesia for extensive spine and spinal cord procedures (eg, spinal instrumentation or vascular procedures)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70490","name":"Ct soft tissue neck w/o dye","description":"Computed tomography, soft tissue neck; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88269","name":"Chromosome analys amniotic","description":"Chromosome analysis, in situ for amniotic fluid cells, count cells from 6-12 colonies, 1 karyotype, with banding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78291","name":"Pertl-ven shunt patency test","description":"Peritoneal-venous shunt patency test (eg, for leveen, denver shunt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4344","name":"Cath indw foley 2 way silicn","description":"Indwelling catheter, foley type, two-way, all silicone or polyurethane, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33217","name":"Insert 2 electrode pm-defib","description":"Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32994","name":"Ablate pulm tumor perq crybl","description":"Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4082.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42281","name":"Insertion palate prosthesis","description":"Insertion of pin-retained palatal prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61686","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; infratentorial, complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23630","name":"Optx gr hmrl tbrs fx int fix","description":"Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":655.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21343","name":"Open tx dprsd front sinus fx","description":"Open treatment of depressed frontal sinus fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":872.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87176","name":"Tissue homogenization cultr","description":"Homogenization, tissue, for culture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63282","name":"Bx/exc idrl spine lesn lmbr","description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35261","name":"Rpr blvsl grf oth/thn vn nck","description":"Repair blood vessel with graft other than vein; neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42500","name":"Repair salivary duct","description":"Plastic repair of salivary duct, sialodochoplasty; primary or simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":337.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61607","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2313.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50236","name":"Removal of kidney & ureter","description":"Nephrectomy with total ureterectomy and bladder cuff; through separate incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1185.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83904","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78290","name":"Intestine imaging","description":"Intestine imaging (eg, ectopic gastric mucosa, meckels localization, volvulus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":268.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80307","name":"Drug test prsmv chem anlyzr","description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, eia, elisa, emit, fpia, ia, kims, ria]), chromatography (eg, gc, hplc), and mass spectrometry either with or without chromatography, (eg, dart","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50690","name":"Injection for ureter x-ray","description":"Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86778","name":"Toxoplasma antibody igm","description":"Antibody; toxoplasma, igm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31239","name":"Nsl/sinus endoscopy surg dcr","description":"Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27357","name":"Remove femur lesion/graft","description":"Excision or curettage of bone cyst or benign tumor of femur; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":688.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83520","name":"Immunoassay quant nos nonab","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95717","name":"Eeg phys/qhp 2-12 hr w/o vid","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report, 2-12 hours of eeg recording; without video","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26372","name":"Repair/graft hand tendon","description":"Repair or advancement of profundus tendon, with intact superficialis tendon; secondary with free graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":748.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5650","name":"Tot contact ak/knee disart s","description":"Additions to lower extremity, total contact, above knee or knee disarticulation socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":323.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26541","name":"Repair hand joint with graft","description":"Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88300","name":"Surgical path gross","description":"Level i - surgical pathology, gross examination only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93620","name":"Comp ep evl r at ven pac&rec","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, his bundle recording","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1025.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63307","name":"Remov vert idrl bdy lmbr/sac","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, lumbar or sacral by transperitoneal or retroperitoneal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2211.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74251","name":"X-ray xm sm int 2cntrst std","description":"Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23605","name":"Cltx prx hmrl fx mnpj+-tract","description":"Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88175","name":"Cytopath c/v auto fluid redo","description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0606","name":"Aed garment w elec analysis","description":"Automatic external defibrillator, with integrated electrocardiogram analysis, garment type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58292","name":"Vag hyst t/o & repair compl","description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21315","name":"Clsd tx nsl fx mnpj wo stblj","description":"Closed treatment of nasal bone fracture with manipulation; without stabilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":222.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1093","name":"Wheelchair wide w/ foot rest","description":"Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25119","name":"Partial removal of ulna","description":"Synovectomy, extensor tendon sheath, wrist, single compartment; with resection of distal ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32655","name":"Thoracoscopy resect bullae","description":"Thoracoscopy, surgical; with resection-plication of bullae, includes any pleural procedure when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5105","name":"Plast socket jts/thgh lacer","description":"Below knee, plastic socket, joints and thigh lacer, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69706","name":"Nps surg dilat eust tube bi","description":"Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1010","name":"Add pwr leg elevation","description":"Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69424","name":"Remove ventilating tube","description":"Ventilating tube removal requiring general anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3520","name":"O shoe add felt w leath insl","description":"Orthopedic shoe addition, insole, felt covered with leather","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0617","name":"Automatic ext defibrillator","description":"External defibrillator with integrated electrocardiogram analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44320","name":"Colostomy","description":"Colostomy or skin level cecostomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26437","name":"Realignment of tendons","description":"Realignment of extensor tendon, hand, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":527.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93016","name":"Cv stress test supvj only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6580","name":"Wrist/elbow bowden cable mol","description":"Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58558","name":"Hysteroscopy biopsy","description":"Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without d & c","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":868.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86800","name":"Thyroglobulin antibody","description":"Thyroglobulin antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77523","name":"Proton trmt intermediate","description":"Proton treatment delivery; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37606","name":"Lig int/com carotid art occl","description":"Ligation; internal or common carotid artery, with gradual occlusion, as with selverstone or crutchfield clamp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":646.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59426","name":"Antepartum care only","description":"Antepartum care only; 7 or more visits","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52275","name":"Cystoscopy & revise urethra","description":"Cystourethroscopy, with internal urethrotomy; male","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":425.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6300","name":"Shlder disart int lock elbow","description":"Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84378","name":"Sugars single quant","description":"Sugars (mono-, di-, and oligosaccharides); single quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0491","name":"Tlso 2 piece rigid shell","description":"Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38720","name":"Removal of lymph nodes neck","description":"Cervical lymphadenectomy (complete)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":853.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78266","name":"Gstr empt img sm bwl&colon","description":"Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":348.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4539","name":"Reuse diaper/brief any size","description":"Incontinence product, diaper/brief, reusable, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38747","name":"Remove abdominal lymph nodes","description":"Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and vena caval nodes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87804","name":"Influenza assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; influenza","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77080","name":"Dxa bone density axial","description":"Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46050","name":"I&d perianal abscess supfc","description":"Incision and drainage, perianal abscess, superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1232","name":"Folding ped wc tilt-in-space","description":"Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87280","name":"Respiratory syncytial ag if","description":"Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75803","name":"Lymph vessel x-ray arms/legs","description":"Lymphangiography, extremity only, bilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32655","name":"Thoracoscopy resect bullae","description":"Thoracoscopy, surgical; with resection-plication of bullae, includes any pleural procedure when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":762.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90461","name":"Im admin each addl component","description":"Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78700","name":"Kidney imaging morphol","description":"Kidney imaging morphology;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87260","name":"Adenovirus ag if","description":"Infectious agent antigen detection by immunofluorescent technique; adenovirus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82435","name":"Assay of blood chloride","description":"Chloride; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93555","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99426","name":"Prin care mgmt staff 1st 30","description":"Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or de","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27372","name":"Removal of foreign body","description":"Removal of foreign body, deep, thigh region or knee area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5250","name":"Hip canad sing axi cons fric","description":"Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2749.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93287","name":"Peri-px device eval & prgr","description":"Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93892","name":"Tcd emboli detect w/o inj","description":"Transcranial doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58575","name":"Laps tot hyst resj mal","description":"Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1214.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0193","name":"Powered air flotation bed","description":"Powered air flotation bed (low air loss therapy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78725","name":"Kidney function study","description":"Kidney function study, non-imaging radioisotopic study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37700","name":"Ligation&div long saph vein","description":"Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94664","name":"Demo&/eval pt use inhaler","description":"Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or ippb device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27752","name":"Treatment of tibia fracture","description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43270","name":"Egd lesion ablation","description":"Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49429","name":"Removal of shunt","description":"Removal of peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":383.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95806","name":"Sleep study unatt&resp efft","description":"Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60240","name":"Removal of thyroid","description":"Thyroidectomy, total or complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":778.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43259","name":"Egd us exam duodenum/jejunum","description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25105","name":"Remove wrist joint lining","description":"Arthrotomy, wrist joint; with synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":404.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51595","name":"Remove bladder/revise tract","description":"Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1771.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57010","name":"Colpotomy drg pel abscess","description":"Colpotomy; with drainage of pelvic abscess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2252","name":"Brief chkin by md/qhp, 11-20","description":"Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor le","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31070","name":"Exploration of frontal sinus","description":"Sinusotomy frontal; external, simple (trephine operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67036","name":"Removal of inner eye fluid","description":"Vitrectomy, mechanical, pars plana approach;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14000","name":"Tis trnfr trunk 10 sq cm/<","description":"Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92537","name":"Caloric vstblr test w/rec","description":"Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63075","name":"Neck spine disk surgery","description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1198.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70544","name":"Mr angiography head w/o dye","description":"Magnetic resonance angiography, head; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95911","name":"Nrv cndj test 9-10 studies","description":"Nerve conduction studies; 9-10 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82376","name":"Assay carboxyhb qual","description":"Carboxyhemoglobin; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00176","name":"Anes intraoral px rad surg","description":"Anesthesia for intraoral procedures, including biopsy; radical surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64475","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27750","name":"Treatment of tibia fracture","description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88371","name":"Protein western blot tissue","description":"Protein analysis of tissue by western blot, with interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37239","name":"Open/perq place stent ea add","description":"Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":736.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60000","name":"I&d thyroglssl dux cst infct","description":"Incision and drainage of thyroglossal duct cyst, infected","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6310","name":"Shoulder passive restor comp","description":"Shoulder disarticulation, passive restoration (complete prosthesis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1602.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90839","name":"Psytx crisis initial 60 min","description":"Psychotherapy for crisis; first 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31561","name":"Larynscop remve cart + scop","description":"Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":254.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21386","name":"Opn tx orbit fx periorbital","description":"Open treatment of orbital floor blowout fracture; periorbital approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91020","name":"Gastric motility studies","description":"Gastric motility (manometric) studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":189.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21600","name":"Partial removal of rib","description":"Excision of rib, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":469.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4199","name":"Parenteral sol > 100gm prote","description":"Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":192.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19084","name":"Bx breast add lesion us imag","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":296.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4670","name":"Automatic bp monitor, dial","description":"Automatic blood pressure monitor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81174","name":"Ar gene known famil variant","description":"Ar (androgen receptor) (eg, spinal and bulbar muscular atrophy, kennedy disease, x chromosome inactivation) gene analysis; known familial variant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78135","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":226.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2315","name":"Lens lenticular trifocal","description":"Lenticular, (myodisc), per lens, trifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64897","name":"Nrv grf mltst arm/leg <4 cm","description":"Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1076.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26952","name":"Amputation of finger/thumb","description":"Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (v-y, hood)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44155","name":"Removal of colon/ileostomy","description":"Colectomy, total, abdominal, with proctectomy; with ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2107","name":"Spherocylinder 4.25d/12-2d","description":"Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01230","name":"Anes opn upper 2/3 femur nos","description":"Anesthesia for open procedures involving upper two-thirds of femur; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00534","name":"Anes insertion/rplcmt cvdfb","description":"Anesthesia for transvenous insertion or replacement of pacing cardioverter-defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33505","name":"Repair artery w/tunnel","description":"Repair of anomalous coronary artery from pulmonary artery origin; with construction of intrapulmonary artery tunnel (takeuchi procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01682","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6642","name":"Excursion amplifier lever ty","description":"Upper extremity addition, excursion amplifier, lever type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":144.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21630","name":"Radical resection sternum","description":"Radical resection of sternum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1036.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5818","name":"Endo knee-shin frct swg & st","description":"Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99219","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78804","name":"Rp loclzj tum whbdy 2+d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, requiring 2 or more days imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28070","name":"Removal of foot joint lining","description":"Synovectomy; intertarsal or tarsometatarsal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74455","name":"X-ray urethra/bladder","description":"Urethrocystography, voiding, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52305","name":"Cystoscopy and treatment","description":"Cystourethroscopy; with incision or resection of orifice of bladder diverticulum, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88189","name":"Flowcytometry/read 16 & >","description":"Flow cytometry, interpretation; 16 or more markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99374","name":"Home health care supervision","description":"Supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (eg, alzheimers facility) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01941","name":"Anes neuromd/ntrvrt crv/thrc","description":"Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22861","name":"Rev rplcm arthrp 1ntrspc crv","description":"Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2126.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39503","name":"Repair of diaphragm hernia","description":"Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90970","name":"Esrd svc pr day pt 20+","description":"End-stage renal disease (esrd) related services for dialysis less than a full month of service, per day; for patients 20 years of age and older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4162","name":"Ef ped specmetabolic inherit","description":"Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35631","name":"Bpg aor-celiac-msn-renal","description":"Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1634.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84431","name":"Thromboxane urine","description":"Thromboxane metabolite(s), including thromboxane if performed, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6255","name":"Absorpt drg >16<=48 in w/bdr","description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27334","name":"Remove knee joint lining","description":"Arthrotomy, with synovectomy, knee; anterior or posterior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68770","name":"Close tear system fistula","description":"Closure of lacrimal fistula (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":377.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49411","name":"Ins mark abd/pel for rt perq","description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":372.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33622","name":"Redo compl cardiac anomaly","description":"Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76815","name":"Ob us limited fetus(s)","description":"Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77334","name":"Radiation treatment aid(s)","description":"Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51030","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01120","name":"Anes px on bony pelvis","description":"Anesthesia for procedures on bony pelvis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29590","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":41.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73200","name":"Ct upper extremity w/o dye","description":"Computed tomography, upper extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6382","name":"Postop dsg cast chg elb dis/","description":"Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":979.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64600","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99415","name":"Prolng clin staff svc 1st hr","description":"Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (list separately in addition to code for out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6637","name":"Nudge control elbow lock","description":"Upper extremity addition, nudge control elbow lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0402T","name":"Colgn crs-link crn&pachymtry","description":"Collagen cross-linking of cornea, including removal of the corneal epithelium, when performed, and intraoperative pachymetry, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":227.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90954","name":"Esrd serv 4 vsts p mo 2-11","description":"End-stage renal disease (esrd) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8614","name":"Cochlear device","description":"Cochlear device, includes all internal and external components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22224","name":"Osteot dsc ant 1vrt sgm lmbr","description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1380.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88380","name":"Microdissection laser","description":"Microdissection (ie, sample preparation of microscopically identified target); laser capture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78428","name":"Cardiac shunt imaging","description":"Cardiac shunt detection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93582","name":"Perq transcath closure pda","description":"Percutaneous transcatheter closure of patent ductus arteriosus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21452","name":"Perq tx mndblr fx xtrnl fixj","description":"Percutaneous treatment of mandibular fracture, with external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0003A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2231","name":"Solid seat support base","description":"Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4360","name":"Pneumat walking boot pre cst","description":"Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6256","name":"Absorpt drg > 48 sq in w/bdr","description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47135","name":"Transplantation of liver","description":"Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4521.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62369","name":"Anal sp inf pmp w/reprg&fill","description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22318","name":"Treat odontoid fx w/o graft","description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95857","name":"Cholinesterase challenge","description":"Cholinesterase inhibitor challenge test for myasthenia gravis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87562","name":"M.avium-intra dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria avium-intracellulare, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29875","name":"Arthrs knee surg synvct lmtd","description":"Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86327","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73650","name":"X-ray exam of heel","description":"Radiologic examination; calcaneus, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11901","name":"Inject skin lesions >7","description":"Injection, intralesional; more than 7 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86602","name":"Antinomyces antibody","description":"Antibody; actinomyces","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0112","name":"Potassium hydroxide preps","description":"All potassium hydroxide (koh) preparations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29049","name":"Appl cast figure-of-eight","description":"Application, cast; figure-of-eight","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33602","name":"Closure of valve","description":"Closure of semilunar valve (aortic or pulmonary) by suture or patch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31367","name":"Partial removal of larynx","description":"Laryngectomy; subtotal supraglottic, without radical neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1642.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46257","name":"Remove in/ex hem grp & fiss","description":"Hemorrhoidectomy, internal and external, single column/group; with fissurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":342.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3334","name":"Shoe lifts elevation heel /i","description":"Lift, elevation, heel, per inch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51525","name":"Removal of bladder lesion","description":"Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4418","name":"Ost pch clsd w/o bar w filtr","description":"Ostomy pouch, closed; without barrier attached, with filter (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37246","name":"Trluml balo angiop 1st art","description":"Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70140","name":"X-ray exam of facial bones","description":"Radiologic examination, facial bones; less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95800","name":"Slp stdy unattended","description":"Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66250","name":"Follow-up surgery of eye","description":"Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93040","name":"Rhythm ecg with report","description":"Rhythm ecg, 1-3 leads; with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0779","name":"Amb infusion pump mechanical","description":"Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63030","name":"Lamot dcmprn nrv rt 1 lmbr","description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35355","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; iliofemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":909.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99425","name":"Prin care mgmt phys ea addl","description":"Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or de","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44210","name":"Laparo total proctocolectomy","description":"Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75731","name":"Artery x-rays adrenal gland","description":"Angiography, adrenal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43496","name":"Free jejunum flap microvasc","description":"Free jejunum transfer with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2343","name":"W/c dpth 22-25 in seat frame","description":"Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54417","name":"Remv/replc penis pros compl","description":"Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":727.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69210","name":"Remove impacted ear wax uni","description":"Removal impacted cerumen requiring instrumentation, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75573","name":"Ct hrt c+ strux cgen hrt ds","description":"Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3d image postprocessing, assessment of left ventricular [lv] cardiac function, right ventricular [rv] structure and function and evaluation of ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95783","name":"Polysom <6 yrs cpap/bilvl","description":"Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61440","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1646.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49420","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8515","name":"Gel cap app device for trach","description":"Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33864","name":"Ascending aortic graft","description":"Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (eg, david procedure, yacoub procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2809.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74340","name":"X-ray guide for gi tube","description":"Introduction of long gastrointestinal tube (eg, miller-abbott), including multiple fluoroscopies and images, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":115.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42415","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0186","name":"Dstry eye lesn,fdr vssl tech","description":"Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2502","name":"Sgd prerec msg >8min <=20min","description":"Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95132","name":"Immntx 3 sting insects","description":"Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 3 stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44150","name":"Removal of colon","description":"Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1532.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78804","name":"Rp loclzj tum whbdy 2+d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, requiring 2 or more days imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6020","name":"Part hand no fingers","description":"Partial hand, no finger remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58285","name":"Extensive hysterectomy","description":"Vaginal hysterectomy, radical (schauta type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58285","name":"Extensive hysterectomy","description":"Vaginal hysterectomy, radical (schauta type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":895.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1702","name":"Repl measr scales jaw motion","description":"Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82805","name":"Blood gases w/o2 saturation","description":"Gases, blood, any combination of ph, pco2, po2, co2, hco3 (including calculated o2 saturation); with o2 saturation, by direct measurement, except pulse oximetry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85130","name":"Chromogenic substrate assay","description":"Chromogenic substrate assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48511","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":778.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78268","name":"Urea breath test c-14 alys","description":"Urea breath test, c-14 (isotopic); analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2060","name":"Hkafo torsion ball bearing j","description":"Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27509","name":"Treatment of thigh fracture","description":"Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":556.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53500","name":"Urethrlys transvag w/ scope","description":"Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28232","name":"Incision of toe tendon","description":"Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74183","name":"Mri abd w/o cntr flwd cntr","description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0221T","name":"Plmt post facet implt lumb","description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19340","name":"Insj breast implt sm d mast","description":"Insertion of breast implant on same day of mastectomy (ie, immediate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25405","name":"Repair/graft radius or ulna","description":"Repair of nonunion or malunion, radius or ulna; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":872.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63304","name":"Remove vert idrl body crvcl","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24071","name":"Exc arm/elbow les sc 3 cm/>","description":"Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27457","name":"Realignment of knee","description":"Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); after epiphyseal closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47800","name":"Reconstruction of bile ducts","description":"Reconstruction, plastic, of extrahepatic biliary ducts with end-to-end anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92018","name":"Compl oph exam general anes","description":"Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87045","name":"Feces culture aerobic bact","description":"Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, kia, lia), salmonella and shigella species","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5520","name":"Perp bk ptb thermopls direct","description":"Preparatory, below knee ptb type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0890","name":"Traction frame attach pelvic","description":"Traction frame, attached to footboard, pelvic traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94004","name":"Vent mgmt nf per day","description":"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; nursing facility, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2323","name":"Special joystick handle","description":"Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1310","name":"Post-operative body jacket","description":"Other scoliosis procedure, post-operative body jacket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1033.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6455","name":"Self-adher band >=5in/yd","description":"Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3674","name":"So airplane w/wo joint cf","description":"Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00174","name":"Anes ntrorl exc rtrphrng tum","description":"Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4604","name":"Tubing with heating element","description":"Tubing with integrated heating element for use with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76519","name":"Echo exam of eye","description":"Ophthalmic biometry by ultrasound echography, a-scan; with intraocular lens power calculation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93580","name":"Transcath closure of asd","description":"Percutaneous transcatheter closure of congenital interatrial communication (ie, fontan fenestration, atrial septal defect) with implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36140","name":"Intro ndl icath upr/lxtr art","description":"Introduction of needle or intracatheter, upper or lower extremity artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42600","name":"Closure of salivary fistula","description":"Closure salivary fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":394.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63047","name":"Lam facetec & foramot lumbar","description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":975.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64405","name":"Njx aa&/strd gr ocpl nrv","description":"Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58563","name":"Hysteroscopy ablation","description":"Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0783","name":"Programmable infusion pump","description":"Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0634","name":"Lso flexion control custom","description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, c","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60100","name":"Biopsy of thyroid","description":"Biopsy thyroid, percutaneous core needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0518","name":"Remove w insert drug implant","description":"Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5910","name":"Endo below knee alignable sy","description":"Addition, endoskeletal system, below knee, alignable system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20611","name":"Drain/inj joint/bursa w/us","description":"Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70390","name":"X-ray exam of salivary duct","description":"Sialography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77285","name":"Ther rad simulaj field intrm","description":"Therapeutic radiology simulation-aided field setting; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28210","name":"Repair/graft of foot tendon","description":"Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82542","name":"Col chromotography qual/quan","description":"Column chromatography, includes mass spectrometry, if performed (eg, hplc, lc, lc/ms, lc/ms-ms, gc, gc/ms-ms, gc/ms, hplc/ms), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20650","name":"Insert and remove bone pin","description":"Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57700","name":"Revision of cervix","description":"Cerclage of uterine cervix, nonobstetrical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63308","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; each additional segment (list separately in addition to codes for single segment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2625","name":"Enlargemnt of eye prosthesis","description":"Enlargement of ocular prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":184.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93291","name":"Interrog dev eval scrms ip","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; subcutaneous cardiac rhythm monitor system, including heart rhythm derived data analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A4397","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0182","name":"Hospice care supervision","description":"Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other stu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10036","name":"Plmt sft tiss loclzj dev ea","description":"Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32503","name":"Resect apical lung tumor","description":"Resection of apical lung tumor (eg, pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; without chest wall reconstruction(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1437.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81182","name":"Atxn8os gen detc abnor allel","description":"Atxn8os (atxn8 opposite strand [non-protein coding]) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43280","name":"Laparoscopy fundoplasty","description":"Laparoscopy, surgical, esophagogastric fundoplasty (eg, nissen, toupet procedures)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":902.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26111","name":"Exc hand les sc 1.5 cm/>","description":"Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; 1.5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5696","name":"Ak/knee disartic pelvic join","description":"Addition to lower extremity, above knee or knee disarticulation, pelvic joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27096","name":"Inject sacroiliac joint","description":"Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or ct) including arthrography when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70332","name":"X-ray exam of jaw joint","description":"Temporomandibular joint arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93612","name":"Intraventricular pacing","description":"Intraventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67840","name":"Remove eyelid lesion","description":"Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":170.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82634","name":"Deoxycortisol","description":"Deoxycortisol, 11-","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21401","name":"Closed tx orbit w/manipulj","description":"Closed treatment of fracture of orbit, except blowout; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":424.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98968","name":"Ph1 assmt&mgmt nqhp 21-30","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86706","name":"Hep b surface antibody","description":"Hepatitis b surface antibody (hbsab)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00220","name":"Anes icr px csf shunting px","description":"Anesthesia for intracranial procedures; cerebrospinal fluid shunting procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20705","name":"Rmvl i-artic rx delivery dev","description":"Removal of drug-delivery device(s), intra-articular (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78020","name":"Thyroid met uptake","description":"Thyroid carcinoma metastases uptake (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2608","name":"Skin pro/pos wc cus wd>=22in","description":"Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96445","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":279.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27227","name":"Treat hip fracture(s)","description":"Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93264","name":"Rem mntr wrls p-art prs snr","description":"Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28046","name":"Resect foot/toe tumor < 3 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":576.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36416","name":"Collj capillary blood spec","description":"Collection of capillary blood specimen (eg, finger, heel, ear stick)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0315","name":"Counsel immune <21  5-15 m","description":"Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 5-15 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":204.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27122","name":"Reconstruction of hip socket","description":"Acetabuloplasty; resection, femoral head (eg, girdlestone procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":931.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28545","name":"Treat foot dislocation","description":"Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":251.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8615","name":"Coch implant headset replace","description":"Headset/headpiece for use with cochlear implant device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":220.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97533","name":"Sensory integration","description":"Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58822","name":"Drain ovary abscess percut","description":"Drainage of ovarian abscess; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0190","name":"Positioning cushion","description":"Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64783","name":"Limb nerve surgery add-on","description":"Excision of neuroma; hand or foot, each additional nerve, except same digit (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":185.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86757","name":"Rickettsia antibody","description":"Antibody; rickettsia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2512","name":"Cntct lens gas permbl bifocl","description":"Contact lens, gas permeable, bifocal, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63688","name":"Rev/rmv imp sp npg/r dtch cn","description":"Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87166","name":"Dark field exam w/o collj","description":"Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00882","name":"Anes maj lwr adb vsl ivc lig","description":"Anesthesia for procedures on major lower abdominal vessels; inferior vena cava ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23670","name":"Optx sho dislc fx","description":"Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":736.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50780","name":"Reimplant ureter in bladder","description":"Ureteroneocystostomy; anastomosis of single ureter to bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01960","name":"Anes vaginal delivery only","description":"Anesthesia for vaginal delivery only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42450","name":"Excise sublingual gland","description":"Excision of sublingual gland","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20150","name":"Excision epiphyseal bar","description":"Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through same fascial incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69450","name":"Eardrum revision","description":"Tympanolysis, transcanal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":439.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0439","name":"Ppps, subseq visit","description":"Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35493","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":466.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56625","name":"Vulvectomy simple complete","description":"Vulvectomy simple; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88189","name":"Flowcytometry/read 16 & >","description":"Flow cytometry, interpretation; 16 or more markers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15792","name":"Chem peel nonfacial epidrm","description":"Chemical peel, nonfacial; epidermal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29358","name":"Appl long leg cast brace","description":"Application of long leg cast brace","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73564","name":"X-ray exam knee 4 or more","description":"Radiologic examination, knee; complete, 4 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93615","name":"Esophageal recording","description":"Esophageal recording of atrial electrogram with or without ventricular electrogram(s);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33320","name":"Repair major blood vessel(s)","description":"Suture repair of aorta or great vessels; without shunt or cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":911.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96370","name":"Sc ther infusion addl hr","description":"Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0941","name":"Gravity assisted traction de","description":"Gravity assisted traction device, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93613","name":"Intracardiac ephys 3d mapg","description":"Intracardiac electrophysiologic 3-dimensional mapping (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80168","name":"Assay of ethosuximide","description":"Ethosuximide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4407","name":"Ext wear ost skn barr <=4sqin","description":"Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47600","name":"Cholecystectomy","description":"Cholecystectomy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01780","name":"Anes px vn upr arm&elbw nos","description":"Anesthesia for procedures on veins of upper arm and elbow; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2363","name":"Gr24 sealed leadacid battery","description":"Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0241U","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15829","name":"Rhytidectomy smas flap","description":"Rhytidectomy; superficial musculoaponeurotic system (smas) flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1114.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87475","name":"Lyme dis dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); borrelia burgdorferi, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26785","name":"Treat finger dislocation","description":"Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed, single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19371","name":"Peri-implt capslc brst compl","description":"Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":507.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31546","name":"Remove vc lesion scope/graft","description":"Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78111","name":"Plasma volume multiple","description":"Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30115","name":"Removal of nose polyp(s)","description":"Excision, nasal polyp(s), extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":333.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0046","name":"Elev lgrst lwr exten repl ea","description":"Elevating legrest, lower extension tube, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85292","name":"Clot factor fletcher fact","description":"Clotting; prekallikrein assay (fletcher factor assay)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88304","name":"Tissue exam by pathologist","description":"Level iii - surgical pathology, gross and microscopic examination abortion, induced abscess aneurysm - arterial/ventricular anus, tag appendix, other than incidental artery, atheromatous plaque bartholins gland cyst bone fragment(s), other than pathologic fracture bursa/synovial cyst carpal tunnel t","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80047","name":"Basic metablc pnl ionized ca","description":"Basic metabolic panel (calcium, ionized) this panel must include the following: calcium, ionized (82330) carbon dioxide (bicarbonate) (82374) chloride (82435) creatinine (82565) glucose (82947) potassium (84132) sodium (84295) urea nitrogen (bun) (84520)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95709","name":"Eeg w/o vid ea 12-26hr intmt","description":"Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, each increment of 12-26 hours; with intermittent monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0019T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33273","name":"Repos prev impltbl subq dfb","description":"Repositioning of previously implanted subcutaneous implantable defibrillator electrode","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11446","name":"Exc face-mm b9+marg >4 cm","description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93965","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54406","name":"Remove muti-comp penis pros","description":"Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":591.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66984","name":"Xcapsl ctrc rmvl w/o ecp","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97610","name":"Low frequency non-thermal us","description":"Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00796","name":"Anes iper upr abd lvr trnspl","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; liver transplant (recipient)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26130","name":"Remove wrist joint lining","description":"Synovectomy, carpometacarpal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78473","name":"Gated heart multiple","description":"Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86822","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61563","name":"Excision of skull tumor","description":"Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); without optic nerve decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33465","name":"Replace tricuspid valve","description":"Replacement, tricuspid valve, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72128","name":"Ct chest spine w/o dye","description":"Computed tomography, thoracic spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3211","name":"Surgical boot each junior","description":"Surgical boot, each, junior","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15824","name":"Rhytidectomy forehead","description":"Rhytidectomy; forehead","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":767.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0460","name":"Tlso 2 shl symphys-stern cst","description":"Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":488.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25560","name":"Cltx rdl&uln shft fx wo mnpj","description":"Closed treatment of radial and ulnar shaft fractures; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78815","name":"Pet image w/ct skull-thigh","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; skull base to mid-thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1227.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31535","name":"Laryngoscopy w/biopsy","description":"Laryngoscopy, direct, operative, with biopsy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86813","name":"Hla typing a b or c","description":"Hla typing; a, b, or c, multiple antigens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38792","name":"Ra tracer id of sentinl node","description":"Injection procedure; radioactive tracer for identification of sentinel node","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76982","name":"Use 1st target lesion","description":"Ultrasound, elastography; first target lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3204","name":"Hightop w/ supp/pronator inf","description":"Orthopedic shoe, hightop with supinator or pronator, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0862","name":"Pwc gp3 hd mult pow opt s/b","description":"Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0281","name":"Elec stim unattend for press","description":"Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2307","name":"Lens sphcy trifocal 4.25-7/.","description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, .12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7033","name":"Replacement nasal pillows","description":"Pillow for use on nasal cannula type interface, replacement only, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11646","name":"Exc f/e/e/n/l mal+mrg >4 cm","description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75996","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93540","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":243.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35518","name":"Art byp grft axillary-axilry","description":"Bypass graft, with vein; axillary-axillary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31032","name":"Explore sinus remove polyps","description":"Sinusotomy, maxillary (antrotomy); radical (caldwell-luc) with removal of antrochoanal polyps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6246","name":"Hydrogel drg >16<=48 in w/b","description":"Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73592","name":"X-ray exam of leg infant","description":"Radiologic examination; lower extremity, infant, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2220","name":"Lens bifocal add over 3.25d","description":"Bifocal add over 3.25d","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84138","name":"Assay of pregnanetriol","description":"Pregnanetriol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23480","name":"Revision of collar bone","description":"Osteotomy, clavicle, with or without internal fixation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27615","name":"Resect leg/ankle tum < 5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":871.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93980","name":"Penile vascular study","description":"Duplex scan of arterial inflow and venous outflow of penile vessels; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8030","name":"Breast prosthes w/o adhesive","description":"Breast prosthesis, silicone or equal, without integral adhesive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76510","name":"Oph us dx b-scan&quan a-scan","description":"Ophthalmic ultrasound, diagnostic; b-scan and quantitative a-scan performed during the same patient encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33224","name":"Insert pacing lead & connect","description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7037","name":"Pos airway pressure tubing","description":"Tubing used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33412","name":"Replacement of aortic valve","description":"Replacement, aortic valve; with transventricular aortic annulus enlargement (konno procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2749.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78258","name":"Esophageal motility","description":"Esophageal motility","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0113","name":"Crutch underarm each wood","description":"Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34714","name":"Opn fem art expos cndt crtj","description":"Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":237.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50380","name":"Rnl autotrnsplj rimpltj kdn","description":"Renal autotransplantation, reimplantation of kidney","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1753.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40801","name":"Drainage of mouth lesion","description":"Drainage of abscess, cyst, hematoma, vestibule of mouth; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":230.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65785","name":"Impltj ntrstrml crnl rng seg","description":"Implantation of intrastromal corneal ring segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1470.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64891","name":"Nrv grf 1strnd hnd/foot >4cm","description":"Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":974.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61108","name":"Tdh pnxr evac&/drg sdrl hmta","description":"Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for evacuation and/or drainage of subdural hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":804.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48153","name":"Pancreatectomy","description":"Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, whipple-type procedure); with pancreatojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2598.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71110","name":"X-ray exam ribs bil 3 views","description":"Radiologic examination, ribs, bilateral; 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44701","name":"Intraop colon lavage add-on","description":"Intraoperative colonic lavage (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92617","name":"Fees w/laryngeal sense i&r","description":"Flexible endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23101","name":"Arthrt acrmclv/strnclav jt","description":"Arthrotomy, acromioclavicular joint or sternoclavicular joint, including biopsy and/or excision of torn cartilage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52345","name":"Cysto/uretero w/up stricture","description":"Cystourethroscopy with ureteroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33958","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43845","name":"Gastroplasty duodenal switch","description":"Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1626.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36100","name":"Establish access to artery","description":"Introduction of needle or intracatheter, carotid or vertebral artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":430.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23146","name":"Removal of bone lesion","description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":524.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65880","name":"Incise inner eye adhesions","description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); corneovitreal adhesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":399.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76820","name":"Umbilical artery echo","description":"Doppler velocimetry, fetal; umbilical artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37182","name":"Insert hepatic shunt (tips)","description":"Insertion of transvenous intrahepatic portosystemic shunt(s) (tips) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4672","name":"Drainage ext line, dialysis","description":"Drainage extension line, sterile, for dialysis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6660","name":"Heavy duty control cable","description":"Upper extremity addition, heavy duty control cable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0671","name":"Pressure pneum appl full leg","description":"Segmental gradient pressure pneumatic appliance, full leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33783","name":"Nikaidoh proc w/ostia implt","description":"Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, nikaidoh procedure); with reimplantation of 1 or both coronary ostia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78452","name":"Ht muscle image spect mult","description":"Myocardial perfusion imaging, tomographic (spect) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or red","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88248","name":"Chromosome analysis 50-100","description":"Chromosome analysis for breakage syndromes; baseline breakage, score 50-100 cells, count 20 cells, 2 karyotypes (eg, for ataxia telangiectasia, fanconi anemia, fragile x)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21805","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":224.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27345","name":"Removal of knee cyst","description":"Excision of synovial cyst of popliteal space (eg, bakers cyst)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":406.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53855","name":"Insert prost urethral stent","description":"Insertion of a temporary prostatic urethral stent, including urethral measurement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0105","name":"Iv hanger","description":"Iv hanger, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4213","name":"20+ cc syringe only","description":"Syringe, sterile, 20 cc or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0415","name":"Open tx post pelvic fxcture","description":"Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1150","name":"Wheelchair standard w/ leg r","description":"Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87103","name":"Blood fungus culture","description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87427","name":"Shiga-like toxin ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; shiga-like toxin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93501","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":806.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13101","name":"Cmplx rpr trunk 2.6-7.5 cm","description":"Repair, complex, trunk; 2.6 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88313","name":"Special stains group 2","description":"Special stain including interpretation and report; group ii, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47362","name":"Repair liver wound","description":"Management of liver hemorrhage; re-exploration of hepatic wound for removal of packing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30117","name":"Removal of intranasal lesion","description":"Excision or destruction (eg, laser), intranasal lesion; internal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6023","name":"Collagen dressing >48 sq in","description":"Collagen dressing, sterile, size more than 48 sq. in., each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0785","name":"Replacement impl pump cathet","description":"Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38232","name":"Bone marrow harvest autolog","description":"Bone marrow harvesting for transplantation; autologous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15958","name":"Exc trchntr pr ulc prep ostc","description":"Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":762.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21740","name":"Reconstruction of sternum","description":"Reconstructive repair of pectus excavatum or carinatum; open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":891.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65435","name":"Curette/treat cornea","description":"Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01402","name":"Anes opn/arth tot kne arthrp","description":"Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86318","name":"Ia infectious agent antibody","description":"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90964","name":"Esrd home pt serv p mo 2-11","description":"End-stage renal disease (esrd) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15620","name":"Delay flap f/c/c/n/ax/g/h/f","description":"Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0112","name":"Crutch underarm pair wood","description":"Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75705","name":"Artery x-rays spine","description":"Angiography, spinal, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43135","name":"Removal of esophagus pouch","description":"Diverticulectomy of hypopharynx or esophagus, with or without myotomy; thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1219.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50525","name":"Close nephrovisceral fistula","description":"Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26670","name":"Treat hand dislocation","description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21150","name":"Rcnstj mdfc lefrtii ant ntru","description":"Reconstruction midface, lefort ii; anterior intrusion (eg, treacher-collins syndrome)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1344.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B5000","name":"Parenteral sol renal-amirosy","description":"Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal-aminosyn-rf, nephramine, renamine-premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6025","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95018","name":"All tstg perq&iq drugs/biol","description":"Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44384","name":"Small bowel endoscopy","description":"Ileoscopy, through stoma; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33813","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1074.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46608","name":"Anoscopy remove for body","description":"Anoscopy; with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60650","name":"Laparoscopy adrenalectomy","description":"Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1021.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43640","name":"Vagotomy & pylorus repair","description":"Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selective","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66170","name":"Glaucoma surgery","description":"Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12037","name":"Intmd rpr s/tr/ext >30.0 cm","description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68720","name":"Create tear sac drain","description":"Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":471.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25310","name":"Transplant forearm tendon","description":"Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61321","name":"Crnec/crnot drg icr abs ittl","description":"Craniectomy or craniotomy, drainage of intracranial abscess; infratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1949.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25210","name":"Removal of wrist bone","description":"Carpectomy; 1 bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70540","name":"Mri orbit/face/neck w/o dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31627","name":"Navigational bronchoscopy","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (list separately in addition to code for primary procedure[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":951.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26037","name":"Decompress fingers/hand","description":"Decompressive fasciotomy, hand (excludes 26035)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38570","name":"Laparoscopy lymph node biop","description":"Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2275","name":"Plastic mod low ext pad/line","description":"Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":59.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2324","name":"Chin cup interface","description":"Power wheelchair accessory, chin cup for chin control interface","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0820","name":"Halo cervical into body jack","description":"Halo procedure, cervical halo incorporated into plaster body jacket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1006.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0940","name":"Trapeze bar free standing","description":"Trapeze bar, free standing, complete with grab bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47711","name":"Excision of bile duct tumor","description":"Excision of bile duct tumor, with or without primary repair of bile duct; extrahepatic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1299.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0412","name":"Open tx iliac spine uni/bil","description":"Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96933","name":"Rcm i&r only 1st lesion","description":"Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; interpretation and report only, first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25020","name":"Decompress forearm 1 space","description":"Decompression fasciotomy, forearm and/or wrist, flexor or extensor compartment; without debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23172","name":"Sequestrectomy scapula","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), scapula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45150","name":"Excision of rectal stricture","description":"Division of stricture of rectum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":346.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29882","name":"Arthrs kne srg mnisc rpr m/l","description":"Arthroscopy, knee, surgical; with meniscus repair (medial or lateral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":582.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2371","name":"Gr27 sealed leadacid battery","description":"Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61304","name":"Crnec/crnot expl supratntorl","description":"Craniectomy or craniotomy, exploratory; supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1497.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28297","name":"Cor hlx vlgs jt arthrd","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26100","name":"Biopsy hand joint lining","description":"Arthrotomy with biopsy; carpometacarpal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5716","name":"Knee-shin exo mech stance ph","description":"Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4529","name":"Ped size brief/diaper sm/med","description":"Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22610","name":"Arthrd pst tq 1ntrspc thrc","description":"Arthrodesis, posterior or posterolateral technique, single interspace; thoracic (with lateral transverse technique, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1120.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72129","name":"Ct chest spine w/dye","description":"Computed tomography, thoracic spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":154.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0189","name":"Lambswool sheepskin pad","description":"Lambswool sheepskin pad, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86157","name":"Cold agglutinin titer","description":"Cold agglutinin; titer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7037","name":"Pos airway pressure tubing","description":"Tubing used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82438","name":"Assay other fluid chlorides","description":"Chloride; other source","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27532","name":"Treat knee fracture","description":"Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2365","name":"U1 sealed leadacid battery","description":"Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9489","name":"Remote e/m est. pt 40mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision makin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28575","name":"Treat foot dislocation","description":"Closed treatment of talotarsal joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2207","name":"Crutch and cane holder","description":"Wheelchair accessory, crutch and cane holder, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21263","name":"Revise eye sockets","description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1904.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58562","name":"Hysteroscopy remove fb","description":"Hysteroscopy, surgical; with removal of impacted foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64614","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6648","name":"Ext pwrd shlder lock/unlock","description":"Upper extremity addition, shoulder lock mechanism, external powered actuator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1584.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92568","name":"Acoustic refl threshold tst","description":"Acoustic reflex testing, threshold","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6584","name":"Elbow fair lead cable molded","description":"Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93451","name":"Right heart cath","description":"Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72200","name":"X-ray exam si joints","description":"Radiologic examination, sacroiliac joints; less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2502","name":"Contact lens pmma bifocal","description":"Contact lens, pmma, bifocal, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47554","name":"Biliary endoscopy thru skin","description":"Biliary endoscopy, percutaneous via t-tube or other tract; with removal of calculus/calculi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0942","name":"Cervical head harness/halter","description":"Cervical head harness/halter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54692","name":"Laparoscopy orchiopexy","description":"Laparoscopy, surgical; orchiopexy for intra-abdominal testis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":613.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27310","name":"Exploration of knee joint","description":"Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":616.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86890","name":"Autologous blood process","description":"Autologous blood or component, collection processing and storage; predeposited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88360","name":"Tumor immunohistochem/manual","description":"Morphometric analysis, tumor immunohistochemistry (eg, her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52334","name":"Create passage to kidney","description":"Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22586","name":"Arthrd pre-sac ntrbdy l5-s1","description":"Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, l5-s1 interspace","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53235","name":"Removal of urethra lesion","description":"Excision of urethral diverticulum (separate procedure); male","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T5001","name":"Position seat spec orth need","description":"Positioning seat for persons with special orthopedic needs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01820","name":"Anes clsd px rds u/w/h bones","description":"Anesthesia for all closed procedures on radius, ulna, wrist, or hand bones","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5321","name":"Ak open end sach","description":"Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1631.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99416","name":"Prolng clin staff svc ea add","description":"Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (list separately in addition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21110","name":"Interdental fixation","description":"Application of interdental fixation device for conditions other than fracture or dislocation, includes removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":662.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0317","name":"Prolong nursin fac eval 15m","description":"Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92596","name":"Ear protector evaluation","description":"Ear protector attenuation measurements","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93225","name":"Xtrnl ecg rec<48 hrs rec","description":"External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33975","name":"Implant ventricular device","description":"Insertion of ventricular assist device; extracorporeal, single ventricle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61520","name":"Removal of brain lesion","description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3410.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47015","name":"Lapt aspir&/njx hep prst cst","description":"Laparotomy, with aspiration and/or injection of hepatic parasitic (eg, amoebic or echinococcal) cyst(s) or abscess(es)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24576","name":"Cltx humrl cndylr fx wo mnpj","description":"Closed treatment of humeral condylar fracture, medial or lateral; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0710","name":"Ctlso a-p-l control w/ inter","description":"Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44208","name":"L colectomy/coloproctostomy","description":"Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49566","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":782.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0316","name":"Prolong inpt eval add15 m","description":"Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4259","name":"Lancets per box","description":"Lancets, per box of 100","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","KL","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9978","name":"Remote e/m new pt 10mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and strai","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61519","name":"Remove brain lining lesion","description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99377","name":"Hospice care supervision","description":"Supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93015","name":"Cv stress test supvj i&r","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38573","name":"Laps pelvic lymphadec","description":"Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":740.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7009","name":"Nebulizer reservoir bottle","description":"Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C8902","name":"Mra w/o fol w/cont, abd","description":"Magnetic resonance angiography without contrast followed by with contrast, abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82000","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00406","name":"Anes integ sys rad brst dsj","description":"Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast with internal mammary node dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25130","name":"Removal of wrist lesion","description":"Excision or curettage of bone cyst or benign tumor of carpal bones;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":372.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4253","name":"Blood glucose/reagent strips","description":"Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","KL","93","NU"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66985","name":"Insert lens prosthesis","description":"Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":460.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23440","name":"Remove/transplant tendon","description":"Resection or transplantation of long tendon of biceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30150","name":"Rhinectomy partial","description":"Rhinectomy; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62252","name":"Csf shunt reprogram","description":"Reprogramming of programmable cerebrospinal shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33702","name":"Repair of heart defects","description":"Repair sinus of valsalva fistula, with cardiopulmonary bypass;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1341.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96422","name":"Chemo ia infusion up to 1 hr","description":"Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30400","name":"Reconstruction of nose","description":"Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":912.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93355","name":"Echo transesophageal (tee)","description":"Echocardiography, transesophageal (tee) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg, tavr, transcatheter pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46751","name":"Repair of anal sphincter","description":"Sphincteroplasty, anal, for incontinence or prolapse; child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64809","name":"Sympathectomy thoracolumbar","description":"Sympathectomy, thoracolumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63076","name":"Neck spine disk surgery","description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":220.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8509","name":"Trach-esoph voice pros md in","description":"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76942","name":"Echo guide for biopsy","description":"Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5506","name":"Diabetic shoe w/off set heel","description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87551","name":"Mycobacteria dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria species, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24925","name":"Amputation follow-up surgery","description":"Amputation, arm through humerus; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":477.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37244","name":"Vasc embolize/occlude bleed","description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86732","name":"Mucormycosis antibody","description":"Antibody; mucormycosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0627","name":"Lo sag ri an/pos pnl pre cst","description":"Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefab","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82550","name":"Assay of ck (cpk)","description":"Creatine kinase (ck), (cpk); total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32036","name":"Thoracostomy w/flap drainage","description":"Thoracostomy; with open flap drainage for empyema","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42830","name":"Removal of adenoids","description":"Adenoidectomy, primary; younger than age 12","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82024","name":"Assay of acth","description":"Adrenocorticotropic hormone (acth)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15730","name":"Mdfc flap w/prsrv vasc pedcl","description":"Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27513","name":"Treatment of thigh fracture","description":"Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1053.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33780","name":"Rpr tga rcnstj clsr vsd","description":"Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, jatene type); with closure of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63741","name":"Install spinal shunt","description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":599.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4152","name":"Ef calorie dense>/=1.5kcal","description":"Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24073","name":"Ex arm/elbow tum deep 5 cm/>","description":"Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":593.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82800","name":"Blood ph","description":"Gases, blood, ph only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97036","name":"App mdlty 1+hubbrd tnk ea 15","description":"Application of a modality to 1 or more areas; hubbard tank, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87076","name":"Culture anaerobe ident each","description":"Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44615","name":"Intestinal stricturoplasty","description":"Intestinal stricturoplasty (enterotomy and enterorrhaphy) with or without dilation, for intestinal obstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":894.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24576","name":"Cltx humrl cndylr fx wo mnpj","description":"Closed treatment of humeral condylar fracture, medial or lateral; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78660","name":"Nuclear exam of tear flow","description":"Radiopharmaceutical dacryocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87800","name":"Detect agnt mult dna direc","description":"Infectious agent detection by nucleic acid (dna or rna), multiple organisms; direct probe(s) technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86705","name":"Hep b core antibody igm","description":"Hepatitis b core antibody (hbcab); igm antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50580","name":"Kidney endoscopy & treatment","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":490.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24361","name":"Reconstruct elbow joint","description":"Arthroplasty, elbow; with distal humeral prosthetic replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49492","name":"Rpr ing hern premie blocked","description":"Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75831","name":"Vein x-ray kidney","description":"Venography, renal, unilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6676","name":"Harness figure of 8 dual con","description":"Upper extremity addition, harness, (e.g., figure of eight type), dual cable design","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53855","name":"Insert prost urethral stent","description":"Insertion of a temporary prostatic urethral stent, including urethral measurement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":599.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32097","name":"Open wedge/bx lung nodule","description":"Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43214","name":"Esophagosc dilate balloon 30","description":"Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37217","name":"Stent placemt retro carotid","description":"Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87015","name":"Specimen infect agnt concntj","description":"Concentration (any type), for infectious agents","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95866","name":"Needle emg hemidiaphragm","description":"Needle electromyography; hemidiaphragm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5678","name":"Bk joint covers pair","description":"Additions to lower extremity, below knee, joint covers, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77046","name":"Mri breast c- unilateral","description":"Magnetic resonance imaging, breast, without contrast material; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98976","name":"Rtm dev sply resp sys 16-30d","description":"Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 16-30 days in a 30-day period","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0813","name":"Pwc gp 1 std port seat/back","description":"Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77409","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":149.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32607","name":"Thoracoscopy w/bx infiltrate","description":"Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":247.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64713","name":"Revision of arm nerve(s)","description":"Neuroplasty, major peripheral nerve, arm or leg, open; brachial plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31552","name":"Laryngoplasty laryngeal sten","description":"Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1103.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40490","name":"Biopsy of lip","description":"Biopsy of lip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72193","name":"Ct pelvis w/dye","description":"Computed tomography, pelvis; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51520","name":"Removal of bladder lesion","description":"Cystotomy; for simple excision of vesical neck (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00731","name":"Anes upr gi ndsc px nos","description":"Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27193","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":384.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25500","name":"Cltx rdl shft fx w/o mnpj","description":"Closed treatment of radial shaft fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62294","name":"Injection into spinal artery","description":"Injection procedure, arterial, for occlusion of arteriovenous malformation, spinal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":862.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78231","name":"Salivary glnd img serial img","description":"Salivary gland imaging; with serial images","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11422","name":"Exc h-f-nk-sp b9+marg 1.1-2","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0581T","name":"Abltj mal brst tum perq crtx","description":"Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76831","name":"Echo exam uterus","description":"Saline infusion sonohysterography (sis), including color flow doppler, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78481","name":"Heart first pass single","description":"Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":141.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32225","name":"Partial release of lung","description":"Decortication, pulmonary (separate procedure); partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":792.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1805","name":"Adjust wrist ext & flex dev","description":"Dynamic adjustable wrist extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15576","name":"Pedicle e/n/e/l/ntroral","description":"Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27003","name":"Tnot adductr subq opn neurct","description":"Tenotomy, adductor, subcutaneous, open, with obturator neurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49585","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":368.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7014","name":"Compressor nondispos filter","description":"Filter, nondisposable, used with aerosol compressor or ultrasonic generator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92311","name":"Contact lens fitg aphakia 1","description":"Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, 1 eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4358","name":"Urinary leg or abdomen bag","description":"Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27620","name":"Explore/treat ankle joint","description":"Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86707","name":"Hepatitis be antibody","description":"Hepatitis be antibody (hbeab)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34806","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61698","name":"Brain aneurysm repr complx","description":"Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3671","name":"So cap design w/o jnts cf","description":"Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":399.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0249","name":"Pad water circulating heat u","description":"Pad for water circulating heat unit, for replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22010","name":"I&d p-spine c/t/cerv-thor","description":"Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61545","name":"Excision of brain tumor","description":"Craniotomy with elevation of bone flap; for excision of craniopharyngioma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98966","name":"Ph1 assmt&mgmt nqhp 5-10","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33681","name":"Closure 1 vsd w/wo patch","description":"Closure of single ventricular septal defect, with or without patch;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1597.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28052","name":"Biopsy of foot joint lining","description":"Arthrotomy with biopsy; metatarsophalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":363.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2213","name":"Initiat med assist tx in er","description":"Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82384","name":"Assay three catecholamines","description":"Catecholamines; fractionated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01670","name":"Anes all px vn shoulder&ax","description":"Anesthesia for all procedures on veins of shoulder and axilla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38242","name":"Transplt allo lymphocytes","description":"Allogeneic lymphocyte infusions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0460","name":"Autolog prp not diab ulcer","description":"Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":132.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81183","name":"Atxn10 gene detc abnor allel","description":"Atxn10 (ataxin 10) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88348","name":"Electron microscopy dx","description":"Electron microscopy, diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0326","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9021","name":"Red blood cells unit","description":"Red blood cells, each unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11626","name":"Exc s/n/h/f/g mal+mrg >4 cm","description":"Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52601","name":"Prostatectomy (turp)","description":"Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":589.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64430","name":"Njx aa&/strd pudendal nerve","description":"Injection(s), anesthetic agent(s) and/or steroid; pudendal nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2184","name":"Limited motion knee joint","description":"Addition to lower extremity fracture orthosis, limited motion knee joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93005","name":"Electrocardiogram tracing","description":"Electrocardiogram, routine ecg with at least 12 leads; tracing only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21453","name":"Cltx mndblr fx ntrdntl fixj","description":"Closed treatment of mandibular fracture with interdental fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95911","name":"Nrv cndj test 9-10 studies","description":"Nerve conduction studies; 9-10 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36909","name":"Dialysis circuit embolj","description":"Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":996.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95148","name":"Antigen therapy services","description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 4 single stinging insect venoms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32442","name":"Sleeve pneumonectomy","description":"Removal of lung, pneumonectomy; with resection of segment of trachea followed by broncho-tracheal anastomosis (sleeve pneumonectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35884","name":"Revj fem anast autog vn grf","description":"Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with autogenous vein patch graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1095.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0781","name":"External ambulatory infus pu","description":"Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0123","name":"Screen cerv/vag thin layer","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90961","name":"Esrd srv 2-3 vsts p mo 20+","description":"End-stage renal disease (esrd) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":169.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22526","name":"Idet single level","description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1796.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5073","name":"Urinary pouch on barr w/flng","description":"Ostomy pouch, urinary; for use on barrier with flange (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2623","name":"Adj skin pro wc cus wd>=22in","description":"Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33517","name":"Cabg artery-vein single","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4152","name":"Ef calorie dense>/=1.5kcal","description":"Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15933","name":"Exc sac pr ulc prim str ostc","description":"Excision, sacral pressure ulcer, with primary suture; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26861","name":"Fusion of finger jnt add-on","description":"Arthrodesis, interphalangeal joint, with or without internal fixation; each additional interphalangeal joint (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78494","name":"Heart image spect","description":"Cardiac blood pool imaging, gated equilibrium, spect, at rest, wall motion study plus ejection fraction, with or without quantitative processing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93308","name":"Tte f-up or lmtd","description":"Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26755","name":"Treat finger fracture each","description":"Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87535","name":"Hiv-1 probe&reverse trnscrpj","description":"Infectious agent detection by nucleic acid (dna or rna); hiv-1, amplified probe technique, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88304","name":"Tissue exam by pathologist","description":"Level iii - surgical pathology, gross and microscopic examination abortion, induced abscess aneurysm - arterial/ventricular anus, tag appendix, other than incidental artery, atheromatous plaque bartholins gland cyst bone fragment(s), other than pathologic fracture bursa/synovial cyst carpal tunnel t","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8470","name":"Pros sock single ply bk","description":"Prosthetic sock, single ply, fitting, below knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83088","name":"Assay of histamine","description":"Histamine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0024","name":"Pin srv add 30 min pr m","description":"Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0101T","name":"Esw muscskel sys nos","description":"Extracorporeal shock wave involving musculoskeletal system, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12014","name":"Rpr f/e/e/n/l/m 5.1-7.5 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25447","name":"Arthrp ntrcrp/crp/mtcr ntrps","description":"Arthroplasty, intercarpal or carpometacarpal joints; interposition (eg, tendon)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":691.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27138","name":"Revise hip joint replacement","description":"Revision of total hip arthroplasty; femoral component only, with or without allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1298.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12056","name":"Intmd rpr face/mm 20.1-30.0","description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86382","name":"Neutralization test viral","description":"Neutralization test, viral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27889","name":"Ankle disarticulation","description":"Ankle disarticulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":555.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6905","name":"Hand restoration multiple fi","description":"Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":870.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49185","name":"Sclerotx fluid collection","description":"Sclerotherapy of a fluid collection (eg, lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (eg, ultrasound, fluoroscopy) and radiological supervision and interpretation when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":904.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73502","name":"X-ray exam hip uni 2-3 views","description":"Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0880","name":"Trac stand free stand extrem","description":"Traction stand, free standing, extremity traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21386","name":"Opn tx orbit fx periorbital","description":"Open treatment of orbital floor blowout fracture; periorbital approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":532.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37223","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":959.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66600","name":"Remove iris and lesion","description":"Iridectomy, with corneoscleral or corneal section; for removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92524","name":"Behavral qualit analys voice","description":"Behavioral and qualitative analysis of voice and resonance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78070","name":"Parathyroid planar imaging","description":"Parathyroid planar imaging (including subtraction, when performed);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28080","name":"Removal of foot lesion","description":"Excision, interdigital (morton) neuroma, single, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":426.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5795","name":"Exoskel hip ultra-light mate","description":"Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77770","name":"Hdr rdncl ntrstl/icav brchtx","description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33697","name":"Compl rpr tof w/pulm atresia","description":"Complete repair tetralogy of fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1789.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3330","name":"Lifts elevation metal extens","description":"Lift, elevation, metal extension (skate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":275.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15850","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63272","name":"Excise intrspinl lesion lmbr","description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1704.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86890","name":"Autologous blood process","description":"Autologous blood or component, collection processing and storage; predeposited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4391","name":"Urinary pouch w ex wear barr","description":"Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95782","name":"Polysom <6 yrs 4/> paramtrs","description":"Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21933","name":"Exc back tum deep 5 cm/>","description":"Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31254","name":"Nsl/sins ndsc w/prtl ethmdct","description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":314.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0983","name":"Add pwr joystick","description":"Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4557","name":"Lead wires, pair","description":"Lead wires, (e.g., apnea monitor), per pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31603","name":"Emer tracheostomy ttrach","description":"Tracheostomy, emergency procedure; transtracheal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71550","name":"Mri chest w/o dye","description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61580","name":"Craniofacial approach skull","description":"Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2626","name":"Reduction of eye prosthesis","description":"Reduction of ocular prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77290","name":"Ther rad simulaj field cplx","description":"Therapeutic radiology simulation-aided field setting; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61345","name":"Oth cranial dcmprn pst fossa","description":"Other cranial decompression, posterior fossa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1869.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96004","name":"Phys review of motion tests","description":"Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with writ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78015","name":"Thyroid met imaging","description":"Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81289","name":"Fxn gene known famil variant","description":"Fxn (frataxin) (eg, friedreich ataxia) gene analysis; known familial variant(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6022","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99244","name":"Off/op cnsltj new/est mod 40","description":"Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61070","name":"Brain canal shunt procedure","description":"Puncture of shunt tubing or reservoir for aspiration or injection procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4772","name":"Blood glucose test strips","description":"Blood glucose test strips, for dialysis, per 50","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0046","name":"Elev lgrst lwr exten repl ea","description":"Elevating legrest, lower extension tube, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"M0243","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86702","name":"Hiv-2 antibody","description":"Antibody; hiv-2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32120","name":"Re-exploration of chest","description":"Thoracotomy; for postoperative complications","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34841","name":"Endovasc visc aorta 1 graft","description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":918.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0856","name":"Cervic collar w air bladders","description":"Cervical traction device, with inflatable air bladder(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26494","name":"Hand tendon/muscle transfer","description":"Opponensplasty; hypothenar muscle transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87426","name":"Sarscov coronavirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, sars-cov, s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46742","name":"Repair of imperforated anus","description":"Repair of high imperforate anus with rectourethral or rectovaginal fistula; combined transabdominal and sacroperineal approaches","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45307","name":"Proctosigmoidoscopy fb","description":"Proctosigmoidoscopy, rigid; with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0265","name":"Hosp bed total electr w/ mat","description":"Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21088","name":"Impres&prep facial prosth","description":"Impression and custom preparation; facial prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61330","name":"Dcmprn orbit only transcrnl","description":"Decompression of orbit only, transcranial approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92597","name":"Oral speech device eval","description":"Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73706","name":"Ct angio lwr extr w/o&w/dye","description":"Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86243","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94760","name":"N-invas ear/pls oximetry 1","description":"Noninvasive ear or pulse oximetry for oxygen saturation; single determination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91111","name":"Gi trc img intral esophagus","description":"Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":609.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74210","name":"X-ray xm phrnx&/crv esoph c+","description":"Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62362","name":"Implant spine infusion pump","description":"Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":325.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1725","name":"Cath, translumin non-laser","description":"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15240","name":"Fth/gft f/c/c/m/n/ax/g/h/f20","description":"Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17313","name":"Mohs 1 stage t/a/l","description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86816","name":"Hla typing dr/dq","description":"Hla typing; dr/dq, single antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54162","name":"Lysis penil circumic lesion","description":"Lysis or excision of penile post-circumcision adhesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2260","name":"Reinforced solid stirrup","description":"Addition to lower extremity, reinforced solid stirrup (scott-craig type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26115","name":"Exc hand les sc < 1.5 cm","description":"Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; less than 1.5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":438.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40808","name":"Biopsy of mouth lesion","description":"Biopsy, vestibule of mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21025","name":"Excision of bone lower jaw","description":"Excision of bone (eg, for osteomyelitis or bone abscess); mandible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":660.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49593","name":"Rpr aa hrn 1st 3-10 rdc","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59120","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":717.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86648","name":"Diphtheria antibody","description":"Antibody; diphtheria","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43275","name":"Ercp remove forgn body duct","description":"Endoscopic retrograde cholangiopancreatography (ercp); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44205","name":"Lap colectomy part w/ileum","description":"Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23680","name":"Optx sho dislc neck fx fixj","description":"Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28299","name":"Cor hlx vlgs double osteot","description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":818.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84520","name":"Assay of urea nitrogen","description":"Urea nitrogen; quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28114","name":"Removal of metatarsal heads","description":"Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, clayton type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87209","name":"Smear complex stain","description":"Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22830","name":"Exploration of spinal fusion","description":"Exploration of spinal fusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2492","name":"Knee lift loop drop lock rin","description":"Addition to knee joint, lift loop for drop lock ring","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47720","name":"Fuse gallbladder & bowel","description":"Cholecystoenterostomy; direct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":966.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93231","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2224","name":"Propulsion whl excl tire rep","description":"Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27052","name":"Biopsy of hip joint","description":"Arthrotomy, with biopsy; hip joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2395","name":"Offset knee joint heavy duty","description":"Addition to lower extremity, offset knee joint, heavy duty, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88274","name":"Cytogenetics 25-99","description":"Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23333","name":"Remove shoulder fb deep","description":"Removal of foreign body, shoulder; deep (subfascial or intramuscular)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":391.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26580","name":"Repair cleft hand","description":"Repair cleft hand","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1279.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6023","name":"Collagen dressing >48 sq in","description":"Collagen dressing, sterile, size more than 48 sq. in., each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95060","name":"Oph mucous membrane tests","description":"Ophthalmic mucous membrane tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60500","name":"Explore parathyroid glands","description":"Parathyroidectomy or exploration of parathyroid(s);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33951","name":"Ecmo/ecls insj prph cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78582","name":"Lung ventilat&perfus imaging","description":"Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77013","name":"Ct guide for tissue ablation","description":"Computed tomography guidance for, and monitoring of, parenchymal tissue ablation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15837","name":"Exc excsv skin forearm/hand","description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":552.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92081","name":"Limited visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, autoplot, arc perimeter, or single stimulus level automated test, such as octopus 3 or 7 equivalent)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73525","name":"Contrast x-ray of hip","description":"Radiologic examination, hip, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76497","name":"Unlisted ct procedure","description":"Unlisted computed tomography procedure (eg, diagnostic, interventional)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63252","name":"Revise spine cord vsl thrlmb","description":"Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2801.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42950","name":"Reconstruction of throat","description":"Pharyngoplasty (plastic or reconstructive operation on pharynx)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72126","name":"Ct neck spine w/dye","description":"Computed tomography, cervical spine; with contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0457","name":"Chest shell","description":"Chest shell (cuirass)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60281","name":"Remove thyroid duct lesion","description":"Excision of thyroglossal duct cyst or sinus; recurrent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":479.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87299","name":"Antibody detection nos if","description":"Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31536","name":"Laryngoscopy w/bx & op scope","description":"Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43112","name":"Esphg tot w/thrcm","description":"Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (ie, mckeown esophagectomy or tri-incisional esophagectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2907.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01150","name":"Anes rad px tumor of pelvis","description":"Anesthesia for radical procedures for tumor of pelvis, except hindquarter amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0161","name":"Sitz bath/equipment w/faucet","description":"Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85385","name":"Fibrinogen antigen","description":"Fibrinogen; antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43888","name":"Gstr rstcv px opn rmvl&rplc","description":"Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26705","name":"Treat knuckle dislocation","description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":349.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20611","name":"Drain/inj joint/bursa w/us","description":"Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5020","name":"Tibial tubercle hgt w/ toe f","description":"Partial foot, molded socket, tibial tubercle height, with toe filler","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":983.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61682","name":"Intracranial vessel surgery","description":"Surgery of intracranial arteriovenous malformation; supratentorial, complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4018.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43254","name":"Egd endo mucosal resection","description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":207.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0110T","name":"Nos quant sensory test","description":"Quantitative sensory testing (qst), testing and interpretation per extremity; using other stimuli to assess sensation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33230","name":"Insrt pulse gen w/dual leads","description":"Insertion of implantable defibrillator pulse generator only; with existing dual leads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":329.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77053","name":"X-ray of mammary duct","description":"Mammary ductogram or galactogram, single duct, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51736","name":"Urine flow measurement","description":"Simple uroflowmetry (ufr) (eg, stop-watch flow rate, mechanical uroflowmeter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25248","name":"Remove forearm foreign body","description":"Exploration with removal of deep foreign body, forearm or wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78816","name":"Pet image w/ct full body","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; whole body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43610","name":"Excision of stomach lesion","description":"Excision, local; ulcer or benign tumor of stomach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":817.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5845","name":"Knee-shin sys stance flexion","description":"Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76872","name":"Us transrectal","description":"Ultrasound, transrectal;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83905","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21088","name":"Impres&prep facial prosth","description":"Impression and custom preparation; facial prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4778.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37195","name":"Thrombolytic therapy stroke","description":"Thrombolysis, cerebral, by intravenous infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50576","name":"Kidney endoscopy & treatment","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":455.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37238","name":"Open/perq place stent same","description":"Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50398","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":398.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0420T","name":"Dstrj neurofibroma xtnsv","description":"Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 neurofibromas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":380.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72130","name":"Ct chest spine w/o & w/dye","description":"Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01742","name":"Anes opn/arthrs elbw osteot","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; osteotomy of humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33871","name":"Transvrs a-arch grf hypthrm","description":"Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2854.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27602","name":"Decompression of lower leg","description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":418.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21408","name":"Opn tx orbit fx w/bone grft","description":"Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":758.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0143","name":"Walker folding wheeled w/o s","description":"Walker, folding, wheeled, adjustable or fixed height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35560","name":"Art byp grft aortorenal","description":"Bypass graft, with vein; aortorenal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88289","name":"Chromosome study additional","description":"Chromosome analysis; additional high resolution study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27848","name":"Treat ankle dislocation","description":"Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; with repair or internal or external fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":668.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73700","name":"Ct lower extremity w/o dye","description":"Computed tomography, lower extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1290","name":"Lateral trochanteric pad","description":"Addition to tlso, (low profile), lateral trochanteric pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48153","name":"Pancreatectomy","description":"Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, whipple-type procedure); with pancreatojejunostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83789","name":"Mass spectrometry qual/quan","description":"Mass spectrometry and tandem mass spectrometry (eg, ms, ms/ms, maldi, ms-tof, qtof), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4637","name":"Repl tip cane/crutch/walker","description":"Replacement, tip, cane, crutch, walker, each.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35021","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, innominate, subclavian artery, by thoracic incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1091.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86880","name":"Coombs test direct","description":"Antihuman globulin test (coombs test); direct, each antiserum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92136","name":"Ophthalmic biometry","description":"Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22869","name":"Insj stablj dev w/o dcmprn","description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72194","name":"Ct pelvis w/o & w/dye","description":"Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28725","name":"Arthrodesis subtalar","description":"Arthrodesis; subtalar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25671","name":"Perq skel fix rad/uln dislc","description":"Percutaneous skeletal fixation of distal radioulnar dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":445.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96376","name":"Tx/pro/dx inj same drug adon","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76770","name":"Us exam abdo back wall comp","description":"Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21296","name":"Revision of jaw muscle/bone","description":"Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); intraoral approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":329.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84100","name":"Assay of phosphorus","description":"Phosphorus inorganic (phosphate);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45900","name":"Reduction of rectal prolapse","description":"Reduction of procidentia (separate procedure) under anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29075","name":"Appl cst elbw fngr short arm","description":"Application, cast; elbow to finger (short arm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44143","name":"Partial removal of colon","description":"Colectomy, partial; with end colostomy and closure of distal segment (hartmann type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1378.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93244","name":"Ext ecg>48hr<7d rev&interpj","description":"External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; review and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97551","name":"Caregiver traing ea addl 15","description":"Caregiver training in strategies and techniques to facilitate the patients functional performance in the home or community (eg, activities of daily living [adls], instrumental adls [iadls], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1004","name":"Pwr seat recline mech","description":"Wheelchair accessory, power seating system, recline only, with mechanical shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49426","name":"Revise abdomen-venous shunt","description":"Revision of peritoneal-venous shunt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27619","name":"Exc leg/ankle tum deep <5 cm","description":"Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99416","name":"Prolng clin staff svc ea add","description":"Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (list separately in addition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00924","name":"Anes male gent undscnd tstis","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); undescended testis, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47360","name":"Repair liver wound","description":"Management of liver hemorrhage; complex suture of liver wound or injury, with or without hepatic artery ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45171","name":"Exc rect tum transanal part","description":"Excision of rectal tumor, transanal approach; not including muscularis propria (ie, partial thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95812","name":"Eeg 41-60 minutes","description":"Electroencephalogram (eeg) extended monitoring; 41-60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74240","name":"X-ray xm upr gi trc 1cntrst","description":"Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26641","name":"Treat thumb dislocation","description":"Closed treatment of carpometacarpal dislocation, thumb, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":319.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28430","name":"Cltx talus fracture w/o mnpj","description":"Closed treatment of talus fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":196.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0749","name":"Elec osteogen stim implanted","description":"Osteogenesis stimulator, electrical, surgically implanted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33440","name":"Rplcmt a-valve tlcj autol pv","description":"Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (ross-konno procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2993.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20661","name":"Application halo cranial","description":"Application of halo, including removal; cranial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":436.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29892","name":"Arthrs aid rpr od les/tib fx","description":"Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":529.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6449","name":"Lt compres band >=3in <5in/yd","description":"Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87299","name":"Antibody detection nos if","description":"Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82552","name":"Assay of cpk in blood","description":"Creatine kinase (ck), (cpk); isoenzymes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64778","name":"Digit nerve surgery add-on","description":"Excision of neuroma; digital nerve, each additional digit (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99155","name":"Mod sed oth phys/qhp <5 yrs","description":"Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0297T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2627","name":"Plastic mold recipro hip & c","description":"Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64489","name":"Tap block bi by infusion","description":"Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) bilateral; by continuous infusions (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28092","name":"Removal of toe lesions","description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65755","name":"Corneal transplant","description":"Keratoplasty (corneal transplant); penetrating (in pseudophakia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49407","name":"Image cath fluid trns/vgnl","description":"Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, transvaginal or transrectal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":555.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52400","name":"Cysto cgen post urtl valves","description":"Cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29843","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; for infection, lavage and drainage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":409.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33534","name":"Cabg arterial two","description":"Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1911.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80406","name":"Acth stimulation panel","description":"Acth stimulation panel; for 3 beta-hydroxydehydrogenase deficiency this panel must include the following: cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50694","name":"Plmt ureteral stent prq","description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38531","name":"Open bx/exc inguinofem nodes","description":"Biopsy or excision of lymph node(s); open, inguinofemoral node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67040","name":"Laser treatment of retina","description":"Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6500","name":"Above elbow prosth tiss shap","description":"Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15271","name":"Skin sub graft trnk/arm/leg","description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62272","name":"Ther spi pnxr drg csf","description":"Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1010","name":"Add pwr leg elevation","description":"Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96004","name":"Phys review of motion tests","description":"Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with writ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88381","name":"Microdissection manual","description":"Microdissection (ie, sample preparation of microscopically identified target); manual","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84545","name":"Urea-n clearance test","description":"Urea nitrogen, clearance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33391","name":"Valvuloplasty aortic valve","description":"Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex (eg, leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6154","name":"Wound pouch each","description":"Wound pouch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97113","name":"Aquatic therapy/exercises","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70548","name":"Mr angiography neck w/dye","description":"Magnetic resonance angiography, neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77049","name":"Mri breast c-+ w/cad bi","description":"Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (cad real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53448","name":"Remov/replc ur sphinctr comp","description":"Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff through an infected field at the same operative session including irrigation and debridement of infected tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97171","name":"Athletic trn eval high cmplx","description":"Athletic training evaluation, high complexity, requiring these components: a medical history and physical activity profile, with 3 or more comorbidities that affect physical activity; a comprehensive examination of body systems using standardized tests and measures addressing a total of 4 or more el","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30124","name":"Removal of nose lesion","description":"Excision dermoid cyst, nose; simple, skin, subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95056","name":"Photo tests","description":"Photo tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83080","name":"Assay of b hexosaminidase ea","description":"B-hexosaminidase, each assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93702","name":"Bis xtracell fluid analysis","description":"Bioimpedance spectroscopy (bis), extracellular fluid analysis for lymphedema assessment(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28340","name":"Resect enlarged toe tissue","description":"Reconstruction, toe, macrodactyly; soft tissue resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94060","name":"Evaluation of wheezing","description":"Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90791","name":"Psych diagnostic evaluation","description":"Psychiatric diagnostic evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86771","name":"Shigella antibody","description":"Antibody; shigella","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22600","name":"Arthrd pst tq 1ntrspc crv","description":"Arthrodesis, posterior or posterolateral technique, single interspace; cervical below c2 segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1147.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83872","name":"Assay synovial fluid mucin","description":"Mucin, synovial fluid (ropes test)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0022","name":"Comm hlth intg svs add 30 m","description":"Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30020","name":"Drainage of nose lesion","description":"Drainage abscess or hematoma, nasal septum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0159","name":"Brake for wheeled walker","description":"Brake attachment for wheeled walker, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80438","name":"Trh stimulation panel","description":"Thyrotropin releasing hormone (trh) stimulation panel; 1 hour this panel must include the following: thyroid stimulating hormone (tsh) (84443 x 3)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64605","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9615","name":"Urine specimen collect mult","description":"Catheterization for collection of specimen(s) (multiple patients)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19361","name":"Brst rcnstj latsms drsi flap","description":"Breast reconstruction; with latissimus dorsi flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28024","name":"Exploration of toe joint","description":"Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":369.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33017","name":"Prcrd drg 6yr+ w/o cgen car","description":"Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; 6 years and older without congenital cardiac anomaly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36823","name":"Insertion of cannula(s)","description":"Insertion of arterial and venous cannula(s) for isolated extracorporeal circulation including regional chemotherapy perfusion to an extremity, with or without hyperthermia, with removal of cannula(s) and repair of arteriotomy and venotomy sites","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29885","name":"Arthrs kne srg drlg ost diss","description":"Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0279","name":"Tomosynthesis, mammo","description":"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44100","name":"Biopsy of bowel","description":"Biopsy of intestine by capsule, tube, peroral (1 or more specimens)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0480T","name":"Fxjl abl lsr ea addl 100sqcm","description":"Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93304","name":"Echo transthoracic","description":"Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46910","name":"Destruction anal lesion(s)","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27198","name":"Clsd tx pelvic ring fx","description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; with ma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":255.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66180","name":"Aqueous shunt eye w/graft","description":"Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20924","name":"Removal of tendon for graft","description":"Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":423.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30540","name":"Rpr choanal atresia ntranasl","description":"Repair choanal atresia; intranasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":531.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78610","name":"Brain flow imaging only","description":"Brain imaging, vascular flow only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67110","name":"Repair detached retina","description":"Repair of retinal detachment; by injection of air or other gas (eg, pneumatic retinopexy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2820","name":"Soft interface below knee se","description":"Addition to lower extremity orthosis, soft interface for molded plastic, below knee section","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1110","name":"Ring flange plas/leather mol","description":"Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74301","name":"X-rays at surgery add-on","description":"Cholangiography and/or pancreatography; additional set intraoperative, radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43352","name":"Surgical opening esophagus","description":"Esophagostomy, fistulization of esophagus, external; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":879.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0055T","name":"Bone srgry cmptr ct/mri imag","description":"Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on ct/mri images (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58353","name":"Endometr ablate thermal","description":"Endometrial ablation, thermal, without hysteroscopic guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34501","name":"Repair valve femoral vein","description":"Valvuloplasty, femoral vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93284","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous impla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80412","name":"Crh stimulation panel","description":"Corticotropic releasing hormone (crh) stimulation panel this panel must include the following: cortisol (82533 x 6) adrenocorticotropic hormone (acth) (82024 x 6)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33266","name":"Ablate atria x10sv endo","description":"Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00910","name":"Anes transurethral px nos","description":"Anesthesia for transurethral procedures (including urethrocystoscopy); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37212","name":"Thrombolytic venous therapy","description":"Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43456","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92273","name":"Full field erg w/i&r","description":"Electroretinography (erg), with interpretation and report; full field (ie, fferg, flash erg, ganzfeld erg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57311","name":"Repair urethrovaginal lesion","description":"Closure of urethrovaginal fistula; with bulbocavernosus transplant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":338.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0045","name":"Ftrst compl assembly repl ea","description":"Footrest, complete assembly, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2050","name":"Hkafo torsion cable hip pelv","description":"Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":227.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00300","name":"Anes all px integ h/n/ptrunk","description":"Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35485","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35702","name":"Expl n/flwd surg uxtr art","description":"Exploration not followed by surgical repair, artery; upper extremity (eg, axillary, brachial, radial, ulnar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":354.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01712","name":"Anes px nrv msc upr a&e tnot","description":"Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of upper arm and elbow; tenotomy, elbow to shoulder, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20615","name":"Treatment of bone cyst","description":"Aspiration and injection for treatment of bone cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67101","name":"Repair detached retina crtx","description":"Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95953","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4367","name":"Ostomy belt","description":"Ostomy belt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78466","name":"Heart infarct image","description":"Myocardial imaging, infarct avid, planar; qualitative or quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16035","name":"Escharotomy 1st incision","description":"Escharotomy; initial incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92558","name":"Evoked auditory test qual","description":"Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4178","name":"Parenteral sol amino acid >","description":"Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44144","name":"Partial removal of colon","description":"Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1463.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21188","name":"Reconstruction of midface","description":"Reconstruction midface, osteotomies (other than lefort type) and bone grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1294.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70336","name":"Magnetic image jaw joint","description":"Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43267","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":328.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92943","name":"Prq trluml revsc ch occ ant","description":"Percutaneous transluminal revascularization of chronic total occlusion, single coronary artery, coronary artery branch, or coronary artery bypass graft, and/or subtended major coronary artery branches of the bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; antegrade","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":532.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70487","name":"Ct maxillofacial w/dye","description":"Computed tomography, maxillofacial area; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68761","name":"Close tear duct opening","description":"Closure of the lacrimal punctum; by plug, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4660","name":"Sphyg/bp app w cuff and stet","description":"Sphygmomanometer/blood pressure apparatus with cuff and stethoscope","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0604","name":"Hosp grade elec breast pump","description":"Breast pump, hospital grade, electric (ac and / or dc), any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27507","name":"Treatment of thigh fracture","description":"Open treatment of femoral shaft fracture with plate/screws, with or without cerclage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":822.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22845","name":"Insert spine fixation device","description":"Anterior instrumentation; 2 to 3 vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":656.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99175","name":"Induction of vomiting","description":"Ipecac or similar administration for individual emesis and continued observation until stomach adequately emptied of poison","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34401","name":"Removal of vein clot","description":"Thrombectomy, direct or with catheter; vena cava, iliac vein, by abdominal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0071A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69676","name":"Remove middle ear nerve","description":"Tympanic neurectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76512","name":"Oph us dx b-scan","description":"Ophthalmic ultrasound, diagnostic; b-scan (with or without superimposed non-quantitative a-scan)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00524","name":"Anes clsd ch px pneumocents","description":"Anesthesia for closed chest procedures; pneumocentesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95816","name":"Eeg awake and drowsy","description":"Electroencephalogram (eeg); including recording awake and drowsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93926","name":"Lower extremity study","description":"Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37607","name":"Lig/banding angioacs av fstl","description":"Ligation or banding of angioaccess arteriovenous fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":325.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45160","name":"Excision of rectal lesion","description":"Excision of rectal tumor by proctotomy, transsacral or transcoccygeal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":856.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80416","name":"Renin stimulation panel","description":"Renal vein renin stimulation panel (eg, captopril) this panel must include the following: renin (84244 x 6)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E8001","name":"Upright gait trainer","description":"Gait trainer, pediatric size, upright support, includes all accessories and components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44391","name":"Colonoscopy for bleeding","description":"Colonoscopy through stoma; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":520.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4614","name":"Hand-held pefr meter","description":"Peak expiratory flow rate meter, hand held","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37216","name":"Transcath stent cca w/o eps","description":"Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63663","name":"Revise spine eltrd perq aray","description":"Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":692.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74470","name":"X-ray exam of kidney lesion","description":"Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5410","name":"Postop dsg bk ea add cast ch","description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63661","name":"Remove spine eltrd perq aray","description":"Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0459","name":"Telehealth inpt pharm mgmt","description":"Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49084","name":"Peritoneal lavage","description":"Peritoneal lavage, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99469","name":"Neonate crit care subsq","description":"Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":326.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5930","name":"High activity knee frame","description":"Addition, endoskeletal system, high activity knee control frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3917","name":"Metacarp fx orthosis pre cst","description":"Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72159","name":"Mr angio spine w/o&w/dye","description":"Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99050","name":"Medical services after hrs","description":"Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, saturday or sunday), in addition to basic service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0957","name":"W/c medial thigh support","description":"Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4381","name":"Urinary plastic pouch w/o fp","description":"Ostomy pouch, urinary, for use on faceplate, plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85461","name":"Hemoglobin fetal","description":"Hemoglobin or rbcs, fetal, for fetomaternal hemorrhage; rosette","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36576","name":"Repair tunneled cv cath","description":"Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76700","name":"Us exam abdom complete","description":"Ultrasound, abdominal, real time with image documentation; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95860","name":"Needle emg 1 extremity","description":"Needle electromyography; 1 extremity with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82670","name":"Assay of total estradiol","description":"Estradiol; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35111","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, splenic artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95982","name":"Io ga n-stim subsq w/reprog","description":"Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27650","name":"Repair achilles tendon","description":"Repair, primary, open or percutaneous, ruptured achilles tendon;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32998","name":"Ablate pulm tumor perq rf","description":"Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2604.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29846","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70551","name":"Mri brain stem w/o dye","description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0250","name":"Hosp bed fixed ht w/ mattres","description":"Hospital bed, fixed height, with any type side rails, with mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15780","name":"Dermabrasion total face","description":"Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":542.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82145","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1080","name":"Outrigger","description":"Addition to ctlso or scoliosis orthosis, outrigger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0784","name":"Ext amb infusn pump insulin","description":"External ambulatory infusion pump, insulin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A8002","name":"Soft protect helmet custom","description":"Helmet, protective, soft, custom fabricated, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":234.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67141","name":"Proph rta dtchmnt crtx dthrm","description":"Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; cryotherapy, diathermy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5812","name":"Endo knee-shin frct swg & st","description":"Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36625","name":"Insertion catheter artery","description":"Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); cutdown","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63302","name":"Remove vert xdrl body thrlmb","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by thoracolumbar approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87206","name":"Smear fluorescent/acid stai","description":"Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27048","name":"Exc hip/pelv tum deep < 5 cm","description":"Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":520.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72090","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85348","name":"Coagulation time otr method","description":"Coagulation time; other methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74022","name":"Radex compl aqt abd series","description":"Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27640","name":"Partial removal of tibia","description":"Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29425","name":"Appl short leg cast walking","description":"Application of short leg cast (below knee to toes); walking or ambulatory type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97022","name":"Whirlpool therapy","description":"Application of a modality to 1 or more areas; whirlpool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32667","name":"Thoracoscopy w/w resect addl","description":"Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85612","name":"Viper venom prothrombin time","description":"Russell viper venom time (includes venom); undiluted","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17003","name":"Destruct premalg les 2-14","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (list separately in addition to code for first lesion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95024","name":"Iq tests w/allergenic xtrcs","description":"Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53621","name":"Dilate urethra stricture","description":"Dilation of urethral stricture by passage of filiform and follower, male; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01963","name":"Anes cesarean hysterectomy","description":"Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64493","name":"Inj paravert f jnt l/s 1 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), lumbar or sacral; single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95926","name":"Somatosensory testing","description":"Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3807","name":"Whfo w/o joints pre cst","description":"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97799","name":"Unlisted physcl med/rehab px","description":"Unlisted physical medicine/rehabilitation service or procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91034","name":"Gastroesophageal reflux test","description":"Esophagus, gastroesophageal reflux test; with nasal catheter ph electrode(s) placement, recording, analysis and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":140.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0297","name":"Hosp bed total elect w/o mat","description":"Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30124","name":"Removal of nose lesion","description":"Excision dermoid cyst, nose; simple, skin, subcutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":218.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62367","name":"Analyze spine infus pump","description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming or refill","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6610","name":"Flexible metal hinge pair","description":"Upper extremity additions, flexible metal hinge, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0018","name":"Detach adjust armrst upper","description":"Detachable, adjustable height armrest, upper portion, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81188","name":"Cstb gene detc abnor allele","description":"Cstb (cystatin b) (eg, unverricht-lundborg disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6236","name":"Hydrocolld drg > 48 in w/o b","description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61641","name":"Dilat ic vspsm ea vsl sm ter","description":"Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in same vascular territory (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84154","name":"Assay of psa free","description":"Prostate specific antigen (psa); free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28003","name":"Treatment of foot infection","description":"Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":564.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82679","name":"Assay of estrone","description":"Estrone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2035","name":"Kafo plastic pediatric size","description":"Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78121","name":"Red cell mass multiple","description":"Red cell volume determination (separate procedure); multiple samplings","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80185","name":"Assay of phenytoin total","description":"Phenytoin; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37760","name":"Lig prfratr vn radical 1 leg","description":"Ligation of perforator veins, subfascial, radical (linton type), including skin graft, when performed, open,1 leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":544.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4409","name":"Ost skn barr convex <=4 sq i","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84479","name":"Assay of thyroid (t3 or t4)","description":"Thyroid hormone (t3 or t4) uptake or thyroid hormone binding ratio (thbr)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15946","name":"Exc isch pr ulc prep mus flp","description":"Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1057.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27158","name":"Revision of pelvis","description":"Osteotomy, pelvis, bilateral (eg, congenital malformation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1188.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36406","name":"Vnpnxr<3yrs phy/qhp other vn","description":"Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; other vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25393","name":"Lengthen radius & ulna","description":"Osteoplasty, radius and ulna; lengthening with autograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":956.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38101","name":"Removal of spleen partial","description":"Splenectomy; partial (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85302","name":"Clot inhibit prot c antigen","description":"Clotting inhibitors or anticoagulants; protein c, antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0800","name":"Pov group 1 std up to 300lbs","description":"Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00940","name":"Anes vaginal px nos","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22853","name":"Insj biomechanical device","description":"Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (list separately in addition to code fo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82776","name":"Galactose transferase test","description":"Galactose-1-phosphate uridyl transferase; screen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0209T","name":"Audiometry air & bone","description":"Pure tone audiometry (threshold), automated; air and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27786","name":"Treatment of ankle fracture","description":"Closed treatment of distal fibular fracture (lateral malleolus); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33420","name":"Revision of mitral valve","description":"Valvotomy, mitral valve; closed heart","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1256.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86619","name":"Borrelia antibody","description":"Antibody; borrelia (relapsing fever)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78472","name":"Gated heart planar single","description":"Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6721","name":"Hook/hand, hvy dty, vol open","description":"Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30906","name":"Repeat control of nosebleed","description":"Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; subsequent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78278","name":"Acute gi blood loss imaging","description":"Acute gastrointestinal blood loss imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76825","name":"Echo exam of fetal heart","description":"Echocardiography, fetal, cardiovascular system, real time with image documentation (2d), with or without m-mode recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15620","name":"Delay flap f/c/c/n/ax/g/h/f","description":"Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32670","name":"Thoracoscopy bilobectomy","description":"Thoracoscopy, surgical; with removal of two lobes (bilobectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44050","name":"Reduce bowel obstruction","description":"Reduction of volvulus, intussusception, internal hernia, by laparotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0153","name":"Forearm crutch platform atta","description":"Platform attachment, forearm crutch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80306","name":"Drug test prsmv instrmnt","description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; read by instrument assisted direct optical observation (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26910","name":"Amputate metacarpal bone","description":"Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62143","name":"Rpl b1 flp/prostc plate skl","description":"Replacement of bone flap or prosthetic plate of skull","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":942.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01232","name":"Anes opn px upr 2/3 fem amp","description":"Anesthesia for open procedures involving upper two-thirds of femur; amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25024","name":"Decompress forearm 2 spaces","description":"Decompression fasciotomy, forearm and/or wrist, flexor and extensor compartment; without debridement of nonviable muscle and/or nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":657.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0565","name":"Compressor air power source","description":"Compressor, air power source for equipment which is not self-contained or cylinder driven","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00630","name":"Anes px lumbar region nos","description":"Anesthesia for procedures in lumbar region; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93531","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2606.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50386","name":"Remove stent via transureth","description":"Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64835","name":"Repair of hand or foot nerve","description":"Suture of 1 nerve; median motor thenar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65785","name":"Impltj ntrstrml crnl rng seg","description":"Implantation of intrastromal corneal ring segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84100","name":"Assay of phosphorus","description":"Phosphorus inorganic (phosphate);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43333","name":"Transab esoph hiat hern rpr","description":"Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1055.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26775","name":"Treat finger dislocation","description":"Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0127","name":"Trim nail(s)","description":"Trimming of dystrophic nails, any number","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43360","name":"Gastrointestinal repair","description":"Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with stomach, with or without pyloroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49650","name":"Lap ing hernia repair init","description":"Laparoscopy, surgical; repair initial inguinal hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38530","name":"Biopsy/removal lymph nodes","description":"Biopsy or excision of lymph node(s); open, internal mammary node(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":370.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44380","name":"Small bowel endoscopy br/wa","description":"Ileoscopy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3978","name":"Sewhfo airplane w/jnt(s) cf","description":"Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":877.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76497","name":"Unlisted ct procedure","description":"Unlisted computed tomography procedure (eg, diagnostic, interventional)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6404","name":"Sterile gauze > 48 sq in","description":"Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26236","name":"Partial removal finger bone","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34825","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":588.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4267","name":"Male condom","description":"Contraceptive supply, condom, male, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29240","name":"Strapping of shoulder","description":"Strapping; shoulder (eg, velpeau)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27279","name":"Arthrd si jt plmt tartclr dv","description":"Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, includes obtaining bone graft when performed, unilateral; placement of transarticular device(s) and/or intra-articular device(s) piercing the lateral or medial cortices of the ilium and the lateral cortex of the ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75705","name":"Artery x-rays spine","description":"Angiography, spinal, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33684","name":"Clsr 1 vsd w/wo patch w/vlvt","description":"Closure of single ventricular septal defect, with or without patch; with pulmonary valvotomy or infundibular resection (acyanotic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1643.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87301","name":"Adenovirus ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; adenovirus enteric types 40/41","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0855","name":"Cervical traction equipment","description":"Cervical traction equipment not requiring additional stand or frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34703","name":"Evasc rpr a-unilac ndgft","description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41500","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":361.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2265","name":"Long tongue stirrup","description":"Addition to lower extremity, long tongue stirrup","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62230","name":"Replace/revise brain shunt","description":"Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":759.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92532","name":"Positional nystagmus test","description":"Positional nystagmus test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66982","name":"Xcapsl ctrc rmvl cplx wo ecp","description":"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24120","name":"Exc/crtg b1 cst/b9 tum rds","description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1812","name":"Ko elastic w/joints pre ots","description":"Knee orthosis, elastic with joints, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69603","name":"Revj mstdc rsltg rad mstdc","description":"Revision mastoidectomy; resulting in radical mastoidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92060","name":"Sensorimotor examination","description":"Sensorimotor examination with multiple measurements of ocular deviation (eg, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39200","name":"Resect mediastinal cyst","description":"Resection of mediastinal cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":755.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68810","name":"Probe nasolacrimal duct","description":"Probing of nasolacrimal duct, with or without irrigation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26548","name":"Reconstruct finger joint","description":"Repair and reconstruction, finger, volar plate, interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":641.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84702","name":"Chorionic gonadotropin test","description":"Gonadotropin, chorionic (hcg); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92556","name":"Speech audiometry complete","description":"Speech audiometry threshold; with speech recognition","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58611","name":"Ligate oviduct(s) add-on","description":"Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27215","name":"Treat pelvic fracture(s)","description":"Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral, for pelvic bone fracture patterns that do not disrupt the pelvic ring, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":478.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51535","name":"Repair of ureter lesion","description":"Cystotomy for excision, incision, or repair of ureterocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":632.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64472","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":86.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59130","name":"Treat ectopic pregnancy","description":"Surgical treatment of ectopic pregnancy; abdominal pregnancy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":837.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96139","name":"Psycl/nrpsyc tst tech ea","description":"Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39010","name":"Exploration of chest","description":"Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; transthoracic approach, including either transthoracic or median sternotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":679.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64449","name":"Njx aa&/strd lmbr plex nfs","description":"Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73050","name":"X-ray exam of shoulders","description":"Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0978","name":"Axillary crutch extension","description":"Axillary crutch extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6536","name":"Gc stocking full lngth 18-30","description":"Gradient compression stocking, full length/chap style, 18-30 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43605","name":"Biopsy of stomach","description":"Biopsy of stomach, by laparotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36834","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":622.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26700","name":"Treat knuckle dislocation","description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29905","name":"Subtalar arthro w/exc","description":"Arthroscopy, subtalar joint, surgical; with synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":408.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92563","name":"Tone decay hearing test","description":"Tone decay test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67921","name":"Repair eyelid defect","description":"Repair of entropion; suture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0405","name":"Ekg interpret & report preve","description":"Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00539","name":"Anes tracheobronchial rcnstj","description":"Anesthesia for tracheobronchial reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61750","name":"Incise skull/brain biopsy","description":"Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27040","name":"Biopsy of soft tissues","description":"Biopsy, soft tissue of pelvis and hip area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99151","name":"Mod sed same phys/qhp <5 yrs","description":"Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54670","name":"Repair testis injury","description":"Suture or repair of testicular injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43754","name":"Dx gastr intub w/asp spec","description":"Gastric intubation and aspiration, diagnostic; single specimen (eg, acid analysis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62121","name":"Incise skull repair","description":"Craniotomy for repair of encephalocele, skull base","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33533","name":"Cabg arterial single","description":"Coronary artery bypass, using arterial graft(s); single arterial graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1626.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94760","name":"N-invas ear/pls oximetry 1","description":"Noninvasive ear or pulse oximetry for oxygen saturation; single determination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20527","name":"Njx nzm palmar fascial cord","description":"Injection, enzyme (eg, collagenase), palmar fascial cord (ie, dupuytrens contracture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3673","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":540.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28665","name":"Treat toe dislocation","description":"Closed treatment of interphalangeal joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15931","name":"Exc sacral pr ulc prim sutr","description":"Excision, sacral pressure ulcer, with primary suture;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88177","name":"Cytp fna eval ea addl","description":"Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34709","name":"Plmt xtn prosth evasc rpr","description":"Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer, including pre-procedure sizing and device selection, all nonselec","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78708","name":"K flow/funct image w/drug","description":"Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25927","name":"Amputation of hand","description":"Transmetacarpal amputation;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82803","name":"Blood gases any combination","description":"Gases, blood, any combination of ph, pco2, po2, co2, hco3 (including calculated o2 saturation);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11106","name":"Incal bx skn single les","description":"Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27632","name":"Exc leg/ankle les sc 3 cm/>","description":"Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76814","name":"Ob us nuchal meas add-on","description":"Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33967","name":"Insert i-aort percut device","description":"Insertion of intra-aortic balloon assist device, percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":224.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66983","name":"Cataract surg w/iol 1 stage","description":"Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85385","name":"Fibrinogen antigen","description":"Fibrinogen; antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0576T","name":"Interrog dev eval icds ss ip","description":"Interrogation device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode, with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94060","name":"Evaluation of wheezing","description":"Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78414","name":"Non-imaging heart function","description":"Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without pharmacologic intervention or exercise, single or multiple determinations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61885","name":"Insrt/redo neurostim 1 array","description":"Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":461.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88333","name":"Path consltj surg cyto xm 1","description":"Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75957","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":671.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7039","name":"Filter, non disposable w pap","description":"Filter, non disposable, used with positive airway pressure device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":763.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33510","name":"Cabg vein single","description":"Coronary artery bypass, vein only; single coronary venous graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5060","name":"Symes met fr leath socket ar","description":"Ankle, symes, metal frame, molded leather socket, articulated ankle/foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43337","name":"Thorabd diaphr hern repair","description":"Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1284.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90837","name":"Psytx w pt 60 minutes","description":"Psychotherapy, 60 minutes with patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75557","name":"Cardiac mri for morph","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3003","name":"Foot insert silicone gel eac","description":"Foot, insert, removable, molded to patient model, silicone gel, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43450","name":"Dilate esophagus 1/mult pass","description":"Dilation of esophagus, by unguided sound or bougie, single or multiple passes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29898","name":"Ankle arthroscopy/surgery","description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":463.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93042","name":"Rhythm ecg report","description":"Rhythm ecg, 1-3 leads; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4311","name":"Catheter w/o bag 2-way latex","description":"Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89051","name":"Body fluid cell count","description":"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74425","name":"Urography antegrade rs&i","description":"Urography, antegrade, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3610","name":"Trans shoe caliper plate new","description":"Transfer of an orthosis from one shoe to another, caliper plate, new","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77427","name":"Radiation tx management x5","description":"Radiation treatment management, 5 treatments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83950","name":"Oncoprotein her-2/neu","description":"Oncoprotein; her-2/neu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96376","name":"Tx/pro/dx inj same drug adon","description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69420","name":"Incision of eardrum","description":"Myringotomy including aspiration and/or eustachian tube inflation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92565","name":"Stenger test pure tone","description":"Stenger test, pure tone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11900","name":"Inject skin lesions </w 7","description":"Injection, intralesional; up to and including 7 lesions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71100","name":"X-ray exam ribs uni 2 views","description":"Radiologic examination, ribs, unilateral; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","name":"Office o/p est low 20 min","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 20 minutes must be met or e","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57320","name":"Repair bladder-vagina lesion","description":"Closure of vesicovaginal fistula; vaginal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":345.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44370","name":"Small bowel endoscopy/stent","description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with transendoscopic stent placement (includes predilation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81539","name":"Oncology prostate prob score","description":"Oncology (high-grade prostate cancer), biochemical assay of four proteins (total psa, free psa, intact psa, and human kallikrein-2 [hk2]), utilizing plasma or serum, prognostic algorithm reported as a probability score","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4410","name":"Ost skn barr extnd >4 sq","description":"Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58823","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":756.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0252","name":"Pet imaging initial dx","description":"Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61150","name":"Bur hol/trph drg brn abs/cst","description":"Burr hole(s) or trephine; with drainage of brain abscess or cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1233.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0245","name":"Tub stool or bench","description":"Tub stool or bench","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45342","name":"Sigmoidoscopy w/us guide bx","description":"Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":130.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0295T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2715","name":"Prism lens/es","description":"Prism, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97130","name":"Ther ivntj ea addl 15 min","description":"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99326","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29200","name":"Strapping thorax","description":"Strapping; thorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23220","name":"Radical rescj tumor prox hum","description":"Radical resection of tumor, proximal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1655.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4427","name":"Ost pch drain/barr lk flng/f","description":"Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81171","name":"Aff2 gen aly detc abnl allel","description":"Aff2 (alf transcription elongation factor 2 [fmr2]) (eg, fragile x intellectual disability 2 [fraxe]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27440","name":"Revision of knee joint","description":"Arthroplasty, knee, tibial plateau;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47370","name":"Laparo ablate liver tumor rf","description":"Laparoscopy, surgical, ablation of 1 or more liver tumor(s); radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1043.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31647","name":"Bronchial valve init insert","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":155.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47785","name":"Fuse bile ducts and bowel","description":"Anastomosis, roux-en-y, of intrahepatic biliary ducts and gastrointestinal tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2327","name":"Head control interface mech","description":"Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR","KC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61567","name":"Incision of brain tissue","description":"Craniotomy with elevation of bone flap; for multiple subpial transections, with electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5700","name":"Replace socket below knee","description":"Replacement, socket, below knee, molded to patient model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0472","name":"Rad w backup invasive intrfc","description":"Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1844","name":"Ko w/adj jt rot cntrl molded","description":"Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21740","name":"Reconstruction of sternum","description":"Reconstructive repair of pectus excavatum or carinatum; open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2395","name":"Caster wheel excludes tire","description":"Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30120","name":"Revision of nose","description":"Excision or surgical planing of skin of nose for rhinophyma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62146","name":"Crnop w/autograft<5 cm diam","description":"Cranioplasty with autograft (includes obtaining bone grafts); up to 5 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92540","name":"Basic vestibular evaluation","description":"Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38102","name":"Removal of spleen total","description":"Splenectomy; total, en bloc for extensive disease, in conjunction with other procedure (list in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0039","name":"Leg strap h style each","description":"Leg strap, h style, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84152","name":"Assay of psa complexed","description":"Prostate specific antigen (psa); complexed (direct measurement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76825","name":"Echo exam of fetal heart","description":"Echocardiography, fetal, cardiovascular system, real time with image documentation (2d), with or without m-mode recording;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82274","name":"Assay test for blood fecal","description":"Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27615","name":"Resect leg/ankle tum < 5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36821","name":"Av fusion direct any site","description":"Arteriovenous anastomosis, open; direct, any site (eg, cimino type) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":582.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68505","name":"Partial removal tear gland","description":"Excision of lacrimal gland (dacryoadenectomy), except for tumor; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95811","name":"Polysom 6/>yrs cpap 4/> parm","description":"Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87177","name":"Ova and parasites smears","description":"Ova and parasites, direct smears, concentration and identification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2570","name":"Hip clevis type 2 posit jnt","description":"Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87327","name":"Cryptococcus neoform ag ia","description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [eia], enzyme-linked immunosorbent assay [elisa], fluorescence immunoassay [fia], immunochemiluminometric assay [imca]), qualitative or semiquantitative; cryptococcus neoformans","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36513","name":"Apheresis platelets","description":"Therapeutic apheresis; for platelets","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68325","name":"Revise/graft eyelid lining","description":"Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":393.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17360","name":"Chemical exfoliation acne","description":"Chemical exfoliation for acne (eg, acne paste, acid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24582","name":"Prq skel fix humrl cndylr fx","description":"Percutaneous skeletal fixation of humeral condylar fracture, medial or lateral, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":681.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44151","name":"Removal of colon/ileostomy","description":"Colectomy, total, abdominal, without proctectomy; with continent ileostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50551","name":"Kidney endoscopy","description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73202","name":"Ct uppr extremity w/o&w/dye","description":"Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6706","name":"Term dev mech hook vol open","description":"Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0022","name":"Comm hlth intg svs add 30 m","description":"Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66990","name":"Ophthalmic endoscope add-on","description":"Use of ophthalmic endoscope (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74150","name":"Ct abdomen w/o contrast","description":"Computed tomography, abdomen; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29800","name":"Jaw arthroscopy/surgery","description":"Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":444.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0368","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1224","name":"Wheelchair spec size w/ leg","description":"Wheelchair with detachable arms, elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64913","name":"Nrv rpr w/nrv algrft ea addl","description":"Nerve repair; with nerve allograft, each additional strand (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2700","name":"Balance lens","description":"Balance lens, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34843","name":"Endovasc visc aorta 3 graft","description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23680","name":"Optx sho dislc neck fx fixj","description":"Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":784.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6539","name":"Gc stocking waistlngth 18-30","description":"Gradient compression stocking, waist length, 18-30 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11760","name":"Repair of nail bed","description":"Repair of nail bed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28660","name":"Treat toe dislocation","description":"Closed treatment of interphalangeal joint dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":98.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43773","name":"Lap replace gastr adj device","description":"Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86780","name":"Treponema pallidum","description":"Antibody; treponema pallidum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57531","name":"Removal of cervix radical","description":"Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tube(s), with or without removal of ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0289","name":"Arthro, loose body + chondro","description":"Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67850","name":"Dstrj lesion lid margin <1cm","description":"Destruction of lesion of lid margin (up to 1 cm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31051","name":"Sphenoid sinus surgery","description":"Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25125","name":"Remove/graft forearm lesion","description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0637","name":"Combination sit to stand sys","description":"Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1158.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92273","name":"Full field erg w/i&r","description":"Electroretinography (erg), with interpretation and report; full field (ie, fferg, flash erg, ganzfeld erg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82482","name":"Assay rbc cholinesterase","description":"Cholinesterase; rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51555","name":"Partial removal of bladder","description":"Cystectomy, partial; complicated (eg, postradiation, previous surgery, difficult location)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45825","name":"Repair fistula w/colostomy","description":"Closure of rectourethral fistula; with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37600","name":"Ligation xtrnl carotid art","description":"Ligation; external carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":613.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84132","name":"Assay of serum potassium","description":"Potassium; serum, plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69705","name":"Nps surg dilat eust tube uni","description":"Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61612","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1612.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90792","name":"Psych diag eval w/med srvcs","description":"Psychiatric diagnostic evaluation with medical services","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0565T","name":"Autol cell implt adps hrvg","description":"Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96446","name":"Chemotx admn pertl cav impl","description":"Chemotherapy administration into the peritoneal cavity via implanted port or catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6534","name":"Gc stocking thighlngth 30-40","description":"Gradient compression stocking, thigh length, 30-40 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33474","name":"Revision of pulmonary valve","description":"Valvotomy, pulmonary valve, open heart, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43242","name":"Egd us fine needle bx/aspir","description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27520","name":"Treat kneecap fracture","description":"Closed treatment of patellar fracture, without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35372","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; deep (profunda) femoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43196","name":"Esophagoscp guide wire dilat","description":"Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65815","name":"Drainage of eye","description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48020","name":"Removal of pancreatic stone","description":"Removal of pancreatic calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99457","name":"Rpm tx mgmt 1st 20 min","description":"Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring 1 real-time interactive communication with the patient/caregiver during the calendar month; first 20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86430","name":"Rheumatoid factor test qual","description":"Rheumatoid factor; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95924","name":"Ans parasymp & symp w/tilt","description":"Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77338","name":"Design mlc device for imrt","description":"Multi-leaf collimator (mlc) device(s) for intensity modulated radiation therapy (imrt), design and construction per imrt plan","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47741","name":"Fuse gallbladder & bowel","description":"Cholecystoenterostomy; roux-en-y with gastroenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1237.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11006","name":"Dbrdmt skin xtrnl gent per","description":"Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":465.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2394","name":"Drive wheel excludes tire","description":"Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75960","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64640","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent; other peripheral nerve or branch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69220","name":"Clean out mastoid cavity","description":"Debridement, mastoidectomy cavity, simple (eg, routine cleaning)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56605","name":"Biopsy of vulva/perineum","description":"Biopsy of vulva or perineum (separate procedure); 1 lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5658","name":"Socket insert above knee","description":"Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30930","name":"Ther fx nasal inf turbinate","description":"Fracture nasal inferior turbinate(s), therapeutic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26416","name":"Graft hand or finger tendon","description":"Removal of synthetic rod and insertion of extensor tendon graft (includes obtaining graft), hand or finger, each rod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1894","name":"Intro/sheath, non-laser","description":"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45334","name":"Sigmoidoscopy for bleeding","description":"Sigmoidoscopy, flexible; with control of bleeding, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":406.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00870","name":"Anes xtrprtl cystolithotomy","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; cystolithotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4082","name":"Enteral ng tubing w/o stylet","description":"Nasogastric tubing without stylet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87522","name":"Hepatitis c revrs trnscrpj","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis c, quantification, includes reverse transcription when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64417","name":"Njx aa&/strd ax nerve img","description":"Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11011","name":"Debride skin musc at fx site","description":"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":336.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88373","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55875","name":"Transperi needle place pros","description":"Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99384","name":"Prev visit new age 12-17","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92587","name":"Evoked auditory test limited","description":"Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24160","name":"Rmvl prosthhumrl&ulnar cmpnt","description":"Removal of prosthesis, includes debridement and synovectomy when performed; humeral and ulnar components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1059.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92540","name":"Basic vestibular evaluation","description":"Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L4380","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0187","name":"Water pressure mattress","description":"Water pressure mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43116","name":"Partial removal of esophagus","description":"Partial esophagectomy, cervical, with free intestinal graft, including microvascular anastomosis, obtaining the graft and intestinal reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78226","name":"Hepatobiliary system imaging","description":"Hepatobiliary system imaging, including gallbladder when present;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":266.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91312","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6050","name":"Wrst mld sck flx hng tri pad","description":"Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64712","name":"Revision of sciatic nerve","description":"Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80400","name":"Acth stimulation panel","description":"Acth stimulation panel; for adrenal insufficiency this panel must include the following: cortisol (82533 x 2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93050","name":"Art pressure waveform analys","description":"Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity art","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53235","name":"Removal of urethra lesion","description":"Excision of urethral diverticulum (separate procedure); male","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":511.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98971","name":"Nqhp ol dig assmt&mgmt 11-20","description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43242","name":"Egd us fine needle bx/aspir","description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85002","name":"Bleeding time test","description":"Bleeding time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21336","name":"Open tx septal fx w/wo stabj","description":"Open treatment of nasal septal fracture, with or without stabilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86256","name":"Fluorescent antibody titer","description":"Fluorescent noninfectious agent antibody; titer, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43268","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":334.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65125","name":"Revise ocular implant","description":"Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21011","name":"Exc face les sc <2 cm","description":"Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":297.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37203","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1459.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50684","name":"Injection for ureter x-ray","description":"Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87541","name":"Legion pneumo dna amp prob","description":"Infectious agent detection by nucleic acid (dna or rna); legionella pneumophila, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78231","name":"Salivary glnd img serial img","description":"Salivary gland imaging; with serial images","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61641","name":"Dilat ic vspsm ea vsl sm ter","description":"Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in same vascular territory (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":139.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0225","name":"Hydrocollator unit","description":"Hydrocollator unit, includes pads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32140","name":"Removal of lung lesion(s)","description":"Thoracotomy; with cyst(s) removal, includes pleural procedure when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":789.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84484","name":"Assay of troponin quant","description":"Troponin, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78660","name":"Nuclear exam of tear flow","description":"Radiopharmaceutical dacryocystography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0200T","name":"Perq sacral augmt unilat inj","description":"Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1513.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26756","name":"Pin finger fracture each","description":"Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":350.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86651","name":"Encephalitis californ antbdy","description":"Antibody; encephalitis, california (la crosse)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27078","name":"Rsect hip tum incl femur","description":"Radical resection of tumor; ischial tuberosity and greater trochanter of femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38572","name":"Laparoscopy lymphadenectomy","description":"Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":580.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56631","name":"Vlvctmy rad prtl uni lymphad","description":"Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":748.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38740","name":"Remove armpit lymph nodes","description":"Axillary lymphadenectomy; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":467.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35256","name":"Repair blvsl vn grf lxtr","description":"Repair blood vessel with vein graft; lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":898.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92615","name":"Laryngoscopic sensory i&r","description":"Flexible endoscopic evaluation, laryngeal sensory testing by cine or video recording; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0458","name":"Tlso 2mod symphis-xipho pre","description":"Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagitta","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":433.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66635","name":"Removal of iris","description":"Iridectomy, with corneoscleral or corneal section; optical (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00530","name":"Anes perm transvns pm insj","description":"Anesthesia for permanent transvenous pacemaker insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25605","name":"Cltx dst rdl fx/ephys sep w/","description":"Closed treatment of distal radial fracture (eg, colles or smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":453.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27147","name":"Revision of hip bone","description":"Osteotomy, iliac, acetabular or innominate bone; with open reduction of hip","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1243.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0441","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50722","name":"Release of ureter","description":"Ureterolysis for ovarian vein syndrome","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":858.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64744","name":"Incise nerve back of head","description":"Transection or avulsion of; greater occipital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":443.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1887","name":"Catheter, guiding","description":"Catheter, guiding (may include infusion/perfusion capability)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21026","name":"Excision of facial bone(s)","description":"Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25315","name":"Revise palsy hand tendon(s)","description":"Flexor origin slide (eg, for cerebral palsy, volkmann contracture), forearm and/or wrist;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":650.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64622","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":249.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17262","name":"Dstrj mal les t/a/l 1.1-2.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57200","name":"Repair of vagina","description":"Colporrhaphy, suture of injury of vagina (nonobstetrical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34845","name":"Visc & infraren abd 1 prosth","description":"Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1683.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0496","name":"Battery elec/combo vad, rep","description":"Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":730.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01636","name":"Anes open/arthr ntrthrc amp","description":"Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58976","name":"Transfer of embryo","description":"Gamete, zygote, or embryo intrafallopian transfer, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27001","name":"Tenotomy adductor hip open","description":"Tenotomy, adductor of hip, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92520","name":"Laryngeal function studies","description":"Laryngeal function studies (ie, aerodynamic testing and acoustic testing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8685","name":"Implt nrostm pls gen sng rec","description":"Implantable neurostimulator pulse generator, single array, rechargeable, includes extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6369.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9016","name":"Rbc leukocytes reduced","description":"Red blood cells, leukocytes reduced, each unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":219.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77293","name":"Respirator motion mgmt simul","description":"Respiratory motion management simulation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27556","name":"Treat knee dislocation","description":"Open treatment of knee dislocation, includes internal fixation, when performed; without primary ligamentous repair or augmentation/reconstruction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97546","name":"Work hardening add-on","description":"Work hardening/conditioning; each additional hour (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86490","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52630","name":"Remove prostate regrowth","description":"Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":325.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90816","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78282","name":"Gi protein loss","description":"Gastrointestinal protein loss","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26410","name":"Repair hand tendon","description":"Repair, extensor tendon, hand, primary or secondary; without free graft, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":477.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G6010","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97112","name":"Neuromuscular reeducation","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64864","name":"Repair of facial nerve","description":"Suture of facial nerve; extracranial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0442T","name":"Abltj perc plex/trncl nrv","description":"Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4263","name":"Permanent tear duct plug","description":"Permanent, long term, non-dissolvable lacrimal duct implant, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61156","name":"Burr hol aspir hmtm/cst icer","description":"Burr hole(s); with aspiration of hematoma or cyst, intracerebral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1133.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22819","name":"Kyphectomy 3 or more","description":"Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2117.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31628","name":"Bronchoscopy/lung bx each","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":267.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69661","name":"Revise middle ear bone","description":"Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; with footplate drill out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92610","name":"Evaluate swallowing function","description":"Evaluation of oral and pharyngeal swallowing function","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30560","name":"Lysis intranasal synechia","description":"Lysis intranasal synechia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0144","name":"Azithromycin dihydrate, oral","description":"Azithromycin dihydrate, oral, capsules/powder, 1 gram","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57456","name":"Endocerv curettage w/scope","description":"Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":91.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93237","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27645","name":"Resect tibia tumor","description":"Radical resection of tumor; tibia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22633","name":"Arthrd cmbn 1ntrspc lumbar","description":"Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1642.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31805","name":"Repair of windpipe injury","description":"Suture of tracheal wound or injury; intrathoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":650.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65930","name":"Remove blood clot from eye","description":"Removal of blood clot, anterior segment of eye","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91112","name":"Gi wireless capsule measure","description":"Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0239","name":"Hydrocollator unit portable","description":"Hydrocollator unit, portable","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61751","name":"Brain biopsy w/ct/mr guide","description":"Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion; with computed tomography and/or magnetic resonance guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1252.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94667","name":"Mnpj chest wall 1st","description":"Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78802","name":"Rp loclzj tum whbdy 1 d img","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, single day imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53860","name":"Transurethral rf treatment","description":"Transurethral radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1699.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53200","name":"Biopsy of urethra","description":"Biopsy of urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78013","name":"Thyroid imaging w/blood flow","description":"Thyroid imaging (including vascular flow, when performed);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41805","name":"Removal foreign body gum","description":"Removal of embedded foreign body from dentoalveolar structures; soft tissues","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82757","name":"Assay of semen fructose","description":"Fructose, semen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30150","name":"Rhinectomy partial","description":"Rhinectomy; partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":592.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24000","name":"Arthrt elbw expl drg/rmvl fb","description":"Arthrotomy, elbow, including exploration, drainage, or removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":401.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64893","name":"Nrv grf 1strnd arm/leg >4 cm","description":"Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":950.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47741","name":"Fuse gallbladder & bowel","description":"Cholecystoenterostomy; roux-en-y with gastroenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20934","name":"Intercalary algrft compl","description":"Allograft, includes templating, cutting, placement and internal fixation, when performed; intercalary, complete (ie, cylindrical) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":593.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15756","name":"Free myo/skin flap microvasc","description":"Free muscle or myocutaneous flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1458.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95980","name":"Io anal gast n-stim init","description":"Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33501","name":"Repair heart vessel fistula","description":"Repair of coronary arteriovenous or arteriocardiac chamber fistula; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5703","name":"Symes ankle w/o (sach) foot","description":"Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4160","name":"Ef ped caloric dense>/=0.7kc","description":"Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21082","name":"Impres&prep paltl aug prosth","description":"Impression and custom preparation; palatal augmentation prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1175.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25805","name":"Arthrd wrist w/sliding graft","description":"Arthrodesis, wrist; with sliding graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0601","name":"Repl batt silver oxide 1.5 v","description":"Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21550","name":"Biopsy of neck/chest","description":"Biopsy, soft tissue of neck or thorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45347","name":"Sigmoidoscopy w/plcmt stent","description":"Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2311","name":"Lens sphc trifo 7.25-12/.25-","description":"Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93453","name":"R&l hrt cath w/ventriclgrphy","description":"Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1180.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0466","name":"Tlso r fram soft ant pre cst","description":"Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled,","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35189","name":"Rpr acq av fistula thrx&abd","description":"Repair, acquired or traumatic arteriovenous fistula; thorax and abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1334.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74018","name":"Radex abdomen 1 view","description":"Radiologic examination, abdomen; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21159","name":"Rcnst mdfc lfrtiii advm wo i","description":"Reconstruction midface, lefort iii (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without lefort i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2119.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63620","name":"Srs spinal lesion","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1018.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0270","name":"Mnt subs tx for change dx","description":"Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21025","name":"Excision of bone lower jaw","description":"Excision of bone (eg, for osteomyelitis or bone abscess); mandible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15004","name":"Wound prep f/n/hf/g","description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of bo","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4426","name":"Ost pch drain 2 piece system","description":"Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27356","name":"Remove femur lesion/graft","description":"Excision or curettage of bone cyst or benign tumor of femur; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2310","name":"Lens sphc trifocal 4.25-7/>6","description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84182","name":"Protein western blot test","description":"Protein; western blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84392","name":"Assay of urine sulfate","description":"Sulfate, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97116","name":"Gait training therapy","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3217","name":"Ladies shoes hightop depth i","description":"Orthopedic footwear, ladies shoe, hightop, depth inlay, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8428","name":"Ready gradient gauntlet","description":"Gradient pressure aid (gauntlet), ready made","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87153","name":"Dna/rna sequencing","description":"Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16s rrna gene)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15610","name":"Delay flap arms/legs","description":"Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27043","name":"Exc hip pelvis les sc 3 cm/>","description":"Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29040","name":"Appl bdy cst sho to hip head","description":"Application of body cast, shoulder to hips; including head, minerva type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":236.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58180","name":"Partial hysterectomy","description":"Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80430","name":"Growth hormone panel","description":"Growth hormone suppression panel (glucose administration) this panel must include the following: glucose (82947 x 3) human growth hormone (hgh) (83003 x 4)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54640","name":"Orchiopexy ingun/scrot appr","description":"Orchiopexy, inguinal or scrotal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66625","name":"Removal of iris","description":"Iridectomy, with corneoscleral or corneal section; peripheral for glaucoma (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52630","name":"Remove prostate regrowth","description":"Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43211","name":"Esophagoscop mucosal resect","description":"Esophagoscopy, flexible, transoral; with endoscopic mucosal resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80299","name":"Quantitative assay drug","description":"Quantitation of therapeutic drug, not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27050","name":"Biopsy of sacroiliac joint","description":"Arthrotomy, with biopsy; sacroiliac joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14350","name":"Filleted finger/toe flap","description":"Filleted finger or toe flap, including preparation of recipient site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97129","name":"Ther ivntj 1st 15 min","description":"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33430","name":"Replacement of mitral valve","description":"Replacement, mitral valve, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2436.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0114","name":"Fern test","description":"Fern test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26352","name":"Repair/graft hand tendon","description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no mans land); secondary with free graft (includes obtaining graft), each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67311","name":"Revise eye muscle","description":"Strabismus surgery, recession or resection procedure; 1 horizontal muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95816","name":"Eeg awake and drowsy","description":"Electroencephalogram (eeg); including recording awake and drowsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92978","name":"Endoluminl ivus oct c 1st","description":"Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (list separately in addition to code for p","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":301.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2624","name":"Adj skin pro/pos cus<22in","description":"Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97116","name":"Gait training therapy","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62282","name":"Treat spinal canal lesion","description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25116","name":"Remove wrist/forearm lesion","description":"Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":500.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67700","name":"Blepharotomy drg absc eyelid","description":"Blepharotomy, drainage of abscess, eyelid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92604","name":"Reprogram cochlear implt 7/>","description":"Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0184T","name":"Exc rectal tumor endoscopic","description":"Excision of rectal tumor, transanal endoscopic microsurgical approach (ie, tems), including muscularis propria (ie, full thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":533.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0328","name":"Fecal blood scrn immunoassay","description":"Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27475","name":"Surgery to stop leg growth","description":"Arrest, epiphyseal, any method (eg, epiphysiodesis); distal femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":559.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90913","name":"Bfb training ea addl 15 min","description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including emg and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0665","name":"Pneumatic appliance full arm","description":"Non-segmental pneumatic appliance for use with pneumatic compressor, full arm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57505","name":"Endocervical curettage","description":"Endocervical curettage (not done as part of a dilation and curettage)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47511","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":434.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4105","name":"Enzyme cartridge enteral nut","description":"In-line cartridge containing digestive enzyme(s) for enteral feeding, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0327","name":"Colon ca scrn;bld-bsd biomrk","description":"Colorectal cancer screening; blood-based biomarker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14300","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":812.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90811","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2280","name":"Molded inner boot","description":"Addition to lower extremity, molded inner boot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14041","name":"Tis trnfr f/c/c/m/n/a/g/h/f","description":"Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":571.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8693","name":"Aud osseo dev, abutment","description":"Auditory osseointegrated device abutment, any length, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":738.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15757","name":"Free skin flap microvasc","description":"Free skin flap with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1445.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41825","name":"Excision of gum lesion","description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0693","name":"Uvl sys panel 6 ft","description":"Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4396","name":"Peristomal hernia supprt blt","description":"Ostomy belt with peristomal hernia support","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4526","name":"Adult size pull-on med","description":"Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36592","name":"Collect blood from picc","description":"Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2103","name":"Spherocylindr 4.00d/12-2.00d","description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74246","name":"X-ray xm upr gi trc 2cntrst","description":"Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77386","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":311.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5513","name":"Multi den insert custom mold","description":"For diabetics only, multiple density insert, custom molded from model of patients foot, total contact with patients foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2500","name":"Sgd digitized pre-rec <=8min","description":"Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23140","name":"Removal of bone lesion","description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96146","name":"Psycl/nrpsyc tst auto result","description":"Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0237T","name":"Trluml perip athrc brchiocph","description":"Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; brachiocephalic trunk and branches, each vessel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24498","name":"Proph tx w/wo mthylmthcrylt","description":"Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":732.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0004","name":"High strength ltwt whlchr","description":"High strength, lightweight wheelchair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42970","name":"Control nose/throat bleeding","description":"Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); simple, with posterior nasal packs, with or without anterior packs and/or cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23065","name":"Biopsy shoulder tissues","description":"Biopsy, soft tissue of shoulder area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27301","name":"Drain thigh/knee lesion","description":"Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53605","name":"Dilate urethra stricture","description":"Dilation of urethral stricture or vesical neck by passage of sound or urethral dilator, male, general or conduction (spinal) anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4322","name":"Irrigation syringe","description":"Irrigation syringe, bulb or piston, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6110","name":"Elbow mold sock suspension t","description":"Below elbow, molded socket, (muenster or northwestern suspension types)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86658","name":"Enterovirus antibody","description":"Antibody; enterovirus (eg, coxsackie, echo, polio)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4627","name":"Spacer bag/reservoir","description":"Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33223","name":"Relocate pocket for defib","description":"Relocation of skin pocket for implantable defibrillator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52332","name":"Cystoscopy and treatment","description":"Cystourethroscopy, with insertion of indwelling ureteral stent (eg, gibbons or double-j type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":366.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88323","name":"Consltj&reprt matrl prep sld","description":"Consultation and report on referred material requiring preparation of slides","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43288","name":"Esphg thrsc moblj","description":"Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98940","name":"Chiropract manj 1-2 regions","description":"Chiropractic manipulative treatment (cmt); spinal, 1-2 regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34847","name":"Visc & infraren abd 3 prosth","description":"Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43257","name":"Egd w/thrml txmnt gerd","description":"Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96105","name":"Assessment of aphasia","description":"Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by boston diagnostic aphasia examination) with interpretation and report, per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23630","name":"Optx gr hmrl tbrs fx int fix","description":"Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42660","name":"Dilation of salivary duct","description":"Dilation and catheterization of salivary duct, with or without injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43520","name":"Incision of pyloric muscle","description":"Pyloromyotomy, cutting of pyloric muscle (fredet-ramstedt type operation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":565.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77761","name":"Apply intrcav radiat simple","description":"Intracavitary radiation source application; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":315.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69140","name":"Remove ear canal lesion(s)","description":"Excision exostosis(es), external auditory canal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61517","name":"Implt brn intrcv chemotx agt","description":"Implantation of brain intracavitary chemotherapy agent (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92342","name":"Fit spectacles multifocal","description":"Fitting of spectacles, except for aphakia; multifocal, other than bifocal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88140","name":"Sex chromatin identification","description":"Sex chromatin identification; peripheral blood smear, polymorphonuclear drumsticks","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95065","name":"Dir nsl mucous membrane test","description":"Direct nasal mucous membrane test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27648","name":"Injection for ankle x-ray","description":"Injection procedure for ankle arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0500","name":"Mod sedat endo service >5yrs","description":"Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousness ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2370","name":"Patten bottom","description":"Addition to lower extremity, patten bottom","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0482","name":"Drug test def 15-21 classes","description":"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36580","name":"Replace cvad cath","description":"Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43124","name":"Removal of esophagus","description":"Total or partial esophagectomy, without reconstruction (any approach), with cervical esophagostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78835","name":"Rp quan meas single area","description":"Radiopharmaceutical quantification measurement(s) single area (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0246","name":"Transfer tub rail attachment","description":"Transfer tub rail attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31632","name":"Bronchoscopy/lung bx addl","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":46.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73201","name":"Ct upper extremity w/dye","description":"Computed tomography, upper extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":175.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74742","name":"X-ray fallopian tube","description":"Transcervical catheterization of fallopian tube, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0341","name":"Percutaneous islet celltrans","description":"Percutaneous islet cell transplant, includes portal vein catheterization and infusion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82533","name":"Total cortisol","description":"Cortisol; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87650","name":"Strep a dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); streptococcus, group a, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36247","name":"Ins cath abd/l-ext art 3rd","description":"Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1236.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3890","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27472","name":"Repair/graft of thigh","description":"Repair, nonunion or malunion, femur, distal to head and neck; with iliac or other autogenous bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1069.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33971","name":"Aortic circulation assist","description":"Removal of intra-aortic balloon assist device including repair of femoral artery, with or without graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":608.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77336","name":"Radiation physics consult","description":"Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2622","name":"Hip joint adjustable flexion","description":"Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":143.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38550","name":"Removal neck/armpit lesion","description":"Excision of cystic hygroma, axillary or cervical; without deep neurovascular dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":342.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93018","name":"Cv stress test i&r only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38220","name":"Dx bone marrow aspirations","description":"Diagnostic bone marrow; aspiration(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":104.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25263","name":"Repair forearm tendon/muscle","description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":531.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0485","name":"Monitor cable elec vad, rep","description":"Monitor control cable for use with electric ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":171.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99447","name":"Ntrprof ph1/ntrnet/ehr 11-20","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patients treating/requesting physician or other qualified health care profess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53265","name":"Treatment of urethra lesion","description":"Excision or fulguration; urethral caruncle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92235","name":"Fluorescein angrph mltiframe","description":"Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60522","name":"Removal of thymus gland","description":"Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61598","name":"Transpetrosal approach/skull","description":"Transpetrosal approach to posterior cranial fossa, clivus or foramen magnum, including ligation of superior petrosal sinus and/or sigmoid sinus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0011A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84830","name":"Ovulation tests","description":"Ovulation tests, by visual color comparison methods for human luteinizing hormone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58323","name":"Sperm washing","description":"Sperm washing for artificial insemination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72149","name":"Mri lumbar spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97022","name":"Whirlpool therapy","description":"Application of a modality to 1 or more areas; whirlpool","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76983","name":"Use ea addl target lesion","description":"Ultrasound, elastography; each additional target lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38210","name":"T-cell depletion of harvest","description":"Transplant preparation of hematopoietic progenitor cells; specific cell depletion within harvest, t-cell depletion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31649","name":"Bronchial valve remov addl","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0445","name":"Oximeter non-invasive","description":"Oximeter device for measuring blood oxygen levels non-invasively","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22208","name":"Incis spine 3 column adl seg","description":"Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":530.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43244","name":"Egd varices ligation","description":"Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21122","name":"Geniop sldg osteot 2/>","description":"Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99285","name":"Emergency dept visit hi mdm","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95873","name":"Guide nerv destr elec stim","description":"Electrical stimulation for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29581","name":"Appl multlayer cmprn sys leg","description":"Application of multi-layer compression system; leg (below knee), including ankle and foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82017","name":"Acylcarnitines quant","description":"Acylcarnitines; quantitative, each specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2240","name":"Round caliper and plate atta","description":"Addition to lower extremity, round caliper and plate attachment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52330","name":"Cystoscopy and treatment","description":"Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":468.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5987","name":"Shank ft w vert load pylon","description":"All lower extremity prosthesis, shank foot system with vertical loading pylon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1160","name":"Wheelchair fixed arms","description":"Wheelchair, fixed full length arms, swing away detachable elevating legrests","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49557","name":"Rerepair fem hernia blocked","description":"Repair recurrent femoral hernia; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29280","name":"Strapping of hand or finger","description":"Strapping; hand or finger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93041","name":"Rhythm ecg tracing","description":"Rhythm ecg, 1-3 leads; tracing only without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94002","name":"Vent mgmt inpat init day","description":"Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21330","name":"Open tx nose fx w/skele fixj","description":"Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":457.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95922","name":"Autonomic nrv adrenrg inervj","description":"Testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and r-r interval changes during valsalva maneuver and at least 5 minutes of passive tilt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30600","name":"Repair mouth/nose fistula","description":"Repair fistula; oronasal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33400","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1925.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01758","name":"Anes opn/arthrs elbw exc cst","description":"Anesthesia for open or surgical arthroscopic procedures of the elbow; excision of cyst or tumor of humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33957","name":"Ecmo/ecls repos perph cnula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86331","name":"Immunodiffusion ouchterlony","description":"Immunodiffusion; gel diffusion, qualitative (ouchterlony), each antigen or antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6449","name":"Lt compres band >=3in <5in/yd","description":"Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0745","name":"Neuromuscular stim for shock","description":"Neuromuscular stimulator, electronic shock unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97550","name":"Caregiver traing 1st 30 min","description":"Caregiver training in strategies and techniques to facilitate the patients functional performance in the home or community (eg, activities of daily living [adls], instrumental adls [iadls], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GN","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4102","name":"Ef adult fluids and electro","description":"Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0077","name":"Fr cstr asmb sol tire rep ea","description":"Front caster assembly, complete, with solid tire, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93662","name":"Intracardiac ecg (ice)","description":"Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":272.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01670","name":"Anes all px vn shoulder&ax","description":"Anesthesia for all procedures on veins of shoulder and axilla","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73202","name":"Ct uppr extremity w/o&w/dye","description":"Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":190.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95930","name":"Visual ep test cns w/i&r","description":"Visual evoked potential (vep) checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61556","name":"Incise skull/sutures","description":"Craniotomy for craniosynostosis; frontal or parietal bone flap","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1560.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27364","name":"Resect thigh/knee tum 5 cm/>","description":"Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; 5 cm or greater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88377","name":"M/phmtrc alys ishquant/semiq","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4220","name":"Parenteral supply kit premix","description":"Parenteral nutrition supply kit; premix, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0603","name":"Repl batt alkaline 1.5 v","description":"Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22327","name":"Treat thorax spine fracture","description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54110","name":"Treatment of penis lesion","description":"Excision of penile plaque (peyronie disease);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21502","name":"I&d dp abs/hmtm nck rib ostc","description":"Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; with partial rib ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5703","name":"Symes ankle w/o (sach) foot","description":"Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1154.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68200","name":"Treat eyelid by injection","description":"Subconjunctival injection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4230","name":"Infus insulin pump non needl","description":"Infusion set for external insulin pump, non needle cannula type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00566","name":"Anes direct cabg w/o pump","description":"Anesthesia for direct coronary artery bypass grafting; without pump oxygenator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2375","name":"Non-expandable controller","description":"Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87905","name":"Ia nzmtc actv oth/thn virus","description":"Infectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0219T","name":"Plmt post facet implt cerv","description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":491.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S8265","name":"Haberman feeder","description":"Haberman feeder for cleft lip/palate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00740","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15951","name":"Exc trchntr pr ulc ostc","description":"Excision, trochanteric pressure ulcer, with primary suture; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0961","name":"Wheelchair brake extension","description":"Manual wheelchair accessory, wheel lock brake extension (handle), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43501","name":"Surgical repair of stomach","description":"Gastrotomy; with suture repair of bleeding ulcer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1125.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32997","name":"Total lung lavage","description":"Total lung lavage (unilateral)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4725","name":"Dialys sol fld vol > 4999cc","description":"Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62327","name":"Njx interlaminar lmbr/sac","description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":198.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61799","name":"Srs cran les complex addl","description":"Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, complex (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33476","name":"Revision of heart chamber","description":"Right ventricular resection for infundibular stenosis, with or without commissurotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1319.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0619","name":"Apnea monitor w recorder","description":"Apnea monitor, with recording feature","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20615","name":"Treatment of bone cyst","description":"Aspiration and injection for treatment of bone cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":200.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01961","name":"Anes cesarean delivery only","description":"Anesthesia for cesarean delivery only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0522T","name":"Prgrmg dev eval wcs ip","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, wireless cardiac stimulator for left ventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1690","name":"Combination bilateral ho","description":"Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":940.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00561","name":"Anes px heart w/pump<1 yr","description":"Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35256","name":"Repair blvsl vn grf lxtr","description":"Repair blood vessel with vein graft; lower extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3766","name":"Ewhfo w/joint(s) cf","description":"Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":601.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6538","name":"Gc stocking full lngth 40+","description":"Gradient compression stocking, full length/chap style, 40 mmhg or greater, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2780","name":"Non-corrosive finish","description":"Addition to lower extremity orthosis, non-corrosive finish, per bar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27307","name":"Incision of thigh tendons","description":"Tenotomy, percutaneous, adductor or hamstring; multiple tendons","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":404.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59012","name":"Fetal cord puncture prenatal","description":"Cordocentesis (intrauterine), any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22590","name":"Arthrd pst tq craniocervical","description":"Arthrodesis, posterior technique, craniocervical (occiput-c2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29075","name":"Appl cst elbw fngr short arm","description":"Application, cast; elbow to finger (short arm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76380","name":"Cat scan follow-up study","description":"Computed tomography, limited or localized follow-up study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85048","name":"Automated leukocyte count","description":"Blood count; leukocyte (wbc), automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76818","name":"Fetal biophys profile w/nst","description":"Fetal biophysical profile; with non-stress testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90953","name":"Esrd serv 1 visit p mo <2yrs","description":"End-stage renal disease (esrd) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95861","name":"Needle emg 2 extremities","description":"Needle electromyography; 2 extremities with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90472","name":"Immunization admin each add","description":"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74021","name":"Radex abdomen 3+ views","description":"Radiologic examination, abdomen; 3 or more views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46710","name":"Repr per/vag pouch sngl proc","description":"Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; transperineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":925.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58559","name":"Hysteroscopy lysis","description":"Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92270","name":"Electro-oculography w/i&r","description":"Electro-oculography with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7026","name":"Replace chst cmprss sys hose","description":"High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26020","name":"Drain hand tendon sheath","description":"Drainage of tendon sheath, digit and/or palm, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95250","name":"Cont gluc mntr phys/qhp eqp","description":"Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and pr","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31625","name":"Bronchoscopy w/biopsy(s)","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21935","name":"Resect back tum < 5 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74022","name":"Radex compl aqt abd series","description":"Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61305","name":"Crnec/crnot expl infratntorl","description":"Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1836.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60000","name":"I&d thyroglssl dux cst infct","description":"Incision and drainage of thyroglossal duct cyst, infected","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25574","name":"Optx rdl&uln shft fx rds/uln","description":"Open treatment of radial and ulnar shaft fractures, with internal fixation, when performed; of radius or ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41006","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, deep, supramylohyoid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":261.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56820","name":"Colposcopy vulva","description":"Colposcopy of the vulva;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51596","name":"Remove bladder/create pouch","description":"Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large intestine to construct neobladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22548","name":"Arthrd ant toral/xoral c1-c2","description":"Arthrodesis, anterior transoral or extraoral technique, clivus-c1-c2 (atlas-axis), with or without excision of odontoid process","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1784.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63091","name":"Remove vertebral body add-on","description":"Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; each additional segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66250","name":"Follow-up surgery of eye","description":"Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":457.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0839","name":"Pwc gp2 vhd sing pow opt s/b","description":"Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81336","name":"Smn1 gene full gene sequence","description":"Smn1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21247","name":"Reconstruct lower jaw bone","description":"Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1274.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64760","name":"Incision of vagus nerve","description":"Transection or avulsion of; vagus nerve (vagotomy), abdominal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0232T","name":"Njx platelet plasma","description":"Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95810","name":"Polysom 6/> yrs 4/> param","description":"Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29916","name":"Hip arthro w/labral repair","description":"Arthroscopy, hip, surgical; with labral repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97813","name":"Acup 1/> w/estim 1st 15 min","description":"Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27079","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":721.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0050","name":"Ratchet assembly replacement","description":"Ratchet assembly, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5507","name":"Modification diabetic shoe","description":"For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25645","name":"Optx crpl fx oth/thn scph ea","description":"Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":480.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51580","name":"Remove bladder/revise tract","description":"Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1533.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7046","name":"Repl water chamber, pap dev","description":"Water chamber for humidifier, used with positive airway pressure device, replacement, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23800","name":"Arthrodesis glenohumeral jt","description":"Arthrodesis, glenohumeral joint;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":869.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65410","name":"Biopsy of cornea","description":"Biopsy of cornea","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":87.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4387","name":"Ost clsd pouch w att st barr","description":"Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44701","name":"Intraop colon lavage add-on","description":"Intraoperative colonic lavage (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22214","name":"Incis 1 vertebral seg lumbar","description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1313.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58673","name":"Laparoscopy salpingostomy","description":"Laparoscopy, surgical; with salpingostomy (salpingoneostomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27134","name":"Revise hip joint replacement","description":"Revision of total hip arthroplasty; both components, with or without autograft or allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2080","name":"Hkafo unilat torsion cable","description":"Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84143","name":"Assay of 17-hydroxypregneno","description":"17-hydroxypregnenolone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0050","name":"Ratchet assembly replacement","description":"Ratchet assembly, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35266","name":"Rpr blvsl grf oth/th vn uxtr","description":"Repair blood vessel with graft other than vein; upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47144","name":"Prep donor liver 3-segment","description":"Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with trisegmen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0791","name":"Parenteral infusion pump sta","description":"Parenteral infusion pump, stationary, single or multi-channel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88368","name":"Insitu hybridization manual","description":"Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; initial single probe stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72084","name":"X-ray exam entire spi 6/> vw","description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); minimum of 6 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99348","name":"Home/res vst est low mdm 30","description":"Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84490","name":"Assay of feces for trypsin","description":"Trypsin; feces, quantitative, 24-hour collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77777","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93503","name":"Insert/place heart catheter","description":"Insertion and placement of flow directed catheter (eg, swan-ganz) for monitoring purposes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4663","name":"Dialysis blood pressure cuff","description":"Blood pressure cuff only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9980","name":"Remote e/m new pt 30 mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86806","name":"Lymphocytotoxicity assay","description":"Lymphocytotoxicity assay, visual crossmatch; without titration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83633","name":"Test urine for lactose","description":"Lactose, urine, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76705","name":"Echo exam of abdomen","description":"Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":71.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87143","name":"Culture typing glc/hplc","description":"Culture, typing; gas liquid chromatography (glc) or high pressure liquid chromatography (hplc) method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93975","name":"Vascular study","description":"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94680","name":"O2 uptk rst&xers dir simple","description":"Oxygen uptake, expired gas analysis; rest and exercise, direct, simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44721","name":"Prep donor intestine/artery","description":"Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; arterial anastomosis, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27435","name":"Incision of knee joint","description":"Capsulotomy, posterior capsular release, knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10140","name":"I&d hmtma seroma/fluid collj","description":"Incision and drainage of hematoma, seroma or fluid collection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0269T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":317.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47425","name":"Incision of bile duct","description":"Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; with transduodenal sphincterotomy or sphincteroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61783","name":"Scan proc spinal","description":"Stereotactic computer-assisted (navigational) procedure; spinal (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25000","name":"Incision of tendon sheath","description":"Incision, extensor tendon sheath, wrist (eg, de quervains disease)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":281.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83883","name":"Assay nephelometry not spec","description":"Nephelometry, each analyte not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59000","name":"Amniocentesis diagnostic","description":"Amniocentesis; diagnostic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87497","name":"Cytomeg dna quant","description":"Infectious agent detection by nucleic acid (dna or rna); cytomegalovirus, quantification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64486","name":"Tap block unil by injection","description":"Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78000","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27465","name":"Shortening of thigh bone","description":"Osteoplasty, femur; shortening (excluding 64876)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61501","name":"Craniectomy f/osteomyelitis","description":"Craniectomy; for osteomyelitis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31040","name":"Exploration behind upper jaw","description":"Pterygomaxillary fossa surgery, any approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":590.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0456","name":"Tlso flex trnk sj-ss pre cst","description":"Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on t","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64488","name":"Tap block bi injection","description":"Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50974","name":"Ureter endoscopy & biopsy","description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82376","name":"Assay carboxyhb qual","description":"Carboxyhemoglobin; qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93642","name":"Ep evl 1/2chmb trnsvns cvdfb","description":"Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0447T","name":"Rmvl impltbl glucose sensor","description":"Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9978","name":"Remote e/m new pt 10mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and strai","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35860","name":"Explore limb vessels","description":"Exploration for postoperative hemorrhage, thrombosis or infection; extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":733.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47564","name":"Laparo cholecystectomy/explr","description":"Laparoscopy, surgical; cholecystectomy with exploration of common duct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":930.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75820","name":"Vein x-ray arm/leg","description":"Venography, extremity, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24538","name":"Prq skel fix sprcndlr hum fx","description":"Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54390","name":"Repair penis and bladder","description":"Plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2760","name":"Extension per extension per","description":"Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90813","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80414","name":"Testosterone response panel","description":"Chorionic gonadotropin stimulation panel; testosterone response this panel must include the following: testosterone (84403 x 2 on 3 pooled blood samples)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50570","name":"Kidney endoscopy","description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53260","name":"Treatment of urethra lesion","description":"Excision or fulguration; urethral polyp(s), distal urethra","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":166.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87077","name":"Culture aerobic identify","description":"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26020","name":"Drain hand tendon sheath","description":"Drainage of tendon sheath, digit and/or palm, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":462.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28575","name":"Treat foot dislocation","description":"Closed treatment of talotarsal joint dislocation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":308.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67405","name":"Explore/drain eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":513.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5968","name":"Multiaxial ankle w dorsiflex","description":"Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27638","name":"Remove/graft leg bone lesion","description":"Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67228","name":"Treatment x10sv retinopathy","description":"Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":328.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0855","name":"Cervical traction equipment","description":"Cervical traction equipment not requiring additional stand or frame","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92602","name":"Reprogram cochlear implt <7","description":"Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64495","name":"Inj paravert f jnt l/s 3 lev","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), lumbar or sacral; third and any additional level(s) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95868","name":"Ndl emg cranial nrv musc bi","description":"Needle electromyography; cranial nerve supplied muscles, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23491","name":"Reinforce shoulder bones","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; proximal humerus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45111","name":"Partial removal of rectum","description":"Proctectomy; partial resection of rectum, transabdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":882.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73120","name":"X-ray exam of hand","description":"Radiologic examination, hand; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9516","name":"Iodine i-123 sod iodide mic","description":"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82679","name":"Assay of estrone","description":"Estrone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97035","name":"App mdlty 1+ultrasound ea 15","description":"Application of a modality to 1 or more areas; ultrasound, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42420","name":"Excise parotid gland/lesion","description":"Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21026","name":"Excision of facial bone(s)","description":"Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80195","name":"Assay of sirolimus","description":"Sirolimus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92548","name":"Cdp-sot 6 cond w/i&r","description":"Computerized dynamic posturography sensory organization test (cdp-sot), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99492","name":"1st psyc collab care mgmt","description":"Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77762","name":"Apply intrcav radiat interm","description":"Intracavitary radiation source application; intermediate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0499","name":"Hepb screen high risk indiv","description":"Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag re","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69502","name":"Mastoidectomy","description":"Mastoidectomy; complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41108","name":"Biopsy of floor of mouth","description":"Biopsy of floor of mouth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":119.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3921","name":"Hfo w/joint(s) cf","description":"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19020","name":"Mastotomy expl drg absc dp","description":"Mastotomy with exploration or drainage of abscess, deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97150","name":"Group therapeutic procedures","description":"Therapeutic procedure(s), group (2 or more individuals)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35570","name":"Art byp tibial-tib/peroneal","description":"Bypass graft, with vein; tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1301.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97530","name":"Therapeutic activities","description":"Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34702","name":"Evasc rpr a-ao ndgft rpt","description":"Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1630.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99255","name":"Ip/obs consltj new/est hi 80","description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 80 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65757","name":"Prep corneal endo allograft","description":"Backbench preparation of corneal endothelial allograft prior to transplantation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":53.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92260","name":"Ophthalmodynamometry","description":"Ophthalmodynamometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55520","name":"Removal of sperm cord lesion","description":"Excision of lesion of spermatic cord (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29505","name":"Application long leg splint","description":"Application of long leg splint (thigh to ankle or toes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34845","name":"Visc & infraren abd 1 prosth","description":"Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77306","name":"Telethx isodose plan simple","description":"Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6244","name":"Hydrogel drg >48 in w/o bdr","description":"Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40654","name":"Rpr lip fth>1half ver ht/cpx","description":"Repair lip, full thickness; over one-half vertical height, or complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0441","name":"Stationary o2 contents, gas","description":"Stationary oxygen contents, gaseous, 1 months supply = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43645","name":"Lap gastr bypass incl smll i","description":"Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1550.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0574","name":"Ultrasonic generator w svneb","description":"Ultrasonic/electronic aerosol generator with small volume nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27236","name":"Treat thigh fracture","description":"Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1011.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55920","name":"Place needles pelvic for rt","description":"Placement of needles or catheters into pelvic organs and/or genitalia (except prostate) for subsequent interstitial radioelement application","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47700","name":"Exploration of bile ducts","description":"Exploration for congenital atresia of bile ducts, without repair, with or without liver biopsy, with or without cholangiography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":882.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21421","name":"Cltx palatal/max fx wire fix","description":"Closed treatment of palatal or maxillary fracture (lefort i type), with interdental wire fixation or fixation of denture or splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45300","name":"Proctosigmoidoscopy dx","description":"Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85730","name":"Thromboplastin time partial","description":"Thromboplastin time, partial (ptt); plasma or whole blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61585","name":"Orbitocranial approach/skull","description":"Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and elevation of frontal and/or temporal lobe(s); with orbital exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84285","name":"Assay of silica","description":"Silica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47380","name":"Open ablate liver tumor rf","description":"Ablation, open, of 1 or more liver tumor(s); radiofrequency","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6600","name":"Polycentric hinge pair","description":"Upper extremity additions, polycentric hinge, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49440","name":"Place gastrostomy tube perc","description":"Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4255","name":"Glucose monitor platforms","description":"Platforms for home blood glucose monitor, 50 per box","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2396","name":"Caster fork","description":"Power wheelchair accessory, caster fork, any size, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92568","name":"Acoustic refl threshold tst","description":"Acoustic reflex testing, threshold","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29877","name":"Arthrs knee surg dbrdmt/shvg","description":"Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":522.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6154","name":"Wound pouch each","description":"Wound pouch, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50543","name":"Laparo partial nephrectomy","description":"Laparoscopy, surgical; partial nephrectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1205.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27403","name":"Repair of knee cartilage","description":"Arthrotomy with meniscus repair, knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83069","name":"Hemoglobin urine","description":"Hemoglobin; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37619","name":"Ligation of inf vena cava","description":"Ligation of inferior vena cava","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1522.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87511","name":"Gardner vag dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); gardnerella vaginalis, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78600","name":"Brain image < 4 views","description":"Brain imaging, less than 4 static views;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76376","name":"3d render w/intrp postproces","description":"3d rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82140","name":"Assay of ammonia","description":"Ammonia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41008","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submandibular space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54065","name":"Destruction penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63306","name":"Remov vert idrl bdy thrclmbr","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by thoracolumbar approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2257.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99308","name":"Sbsq nf care low mdm 20","description":"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. when using total time on the date of the encounter for code selection, 20 minutes must be met or exce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43647","name":"Lap impl electrode antrum","description":"Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99188","name":"App topical fluoride varnish","description":"Application of topical fluoride varnish by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01482","name":"Anes opn lwr l/a/f rad rescj","description":"Anesthesia for open procedures on bones of lower leg, ankle, and foot; radical resection (including below knee amputation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51784","name":"Anal/urinary muscle study","description":"Electromyography studies (emg) of anal or urethral sphincter, other than needle, any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61581","name":"Craniofacial approach skull","description":"Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy and/or maxillectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0053","name":"Elevate footrest articulate","description":"Elevating footrests, articulating (telescoping), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5686","name":"Bk back check","description":"Addition to lower extremity, below knee, back check (extension control)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00620","name":"Anes px thrc spine&cord nos","description":"Anesthesia for procedures on thoracic spine and cord, not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1070","name":"Wheelchair detachable foot r","description":"Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0367","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99201","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80305","name":"Drug test prsmv dir opt obs","description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"G0106","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5722","name":"Knee-shin pneum swg frct exo","description":"Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":448.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1600","name":"Ho flex frejka w/cov pre cst","description":"Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81336","name":"Smn1 gene full gene sequence","description":"Smn1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; full gene sequence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35091","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1579.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99381","name":"Init pm e/m new pat infant","description":"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age youn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63302","name":"Remove vert xdrl body thrlmb","description":"Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by thoracolumbar approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1996.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99476","name":"Ped crit care age 2-5 subsq","description":"Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":286.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29046","name":"Appl bdy cst sho to hip b th","description":"Application of body cast, shoulder to hips; including both thighs","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21199","name":"Reconstr lwr jaw w/advance","description":"Osteotomy, mandible, segmental; with genioglossus advancement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":828.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10030","name":"Img gid flu coll drg sft tis","description":"Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70336","name":"Magnetic image jaw joint","description":"Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21461","name":"Optx mndblr fx wo ntrdntl","description":"Open treatment of mandibular fracture; without interdental fixation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86635","name":"Coccidioides antibody","description":"Antibody; coccidioides","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0651","name":"Lso sag-co shell pnl pre ots","description":"Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by ove","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26556","name":"Toe joint transfer","description":"Transfer, free toe joint, with microvascular anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2879.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5782","name":"Hd low limb pros vacuum pump","description":"Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2054.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35471","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2059.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70134","name":"X-ray exam of middle ear","description":"Radiologic examination, internal auditory meati, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4389","name":"Drainable pch w st wear barr","description":"Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27047","name":"Exc hip/pelvis les sc < 3 cm","description":"Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":405.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93014","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0241","name":"Bath tub wall rail","description":"Bath tub wall rail, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31545","name":"Remove vc lesion w/scope","description":"Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99406","name":"Behav chng smoking 3-10 min","description":"Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87220","name":"Tissue exam for fungi","description":"Tissue examination by koh slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33410","name":"Replacement aortic valve opn","description":"Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43314","name":"Tracheo-esophagoplasty cong","description":"Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; with repair of congenital tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2445.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76948","name":"Echo guide ova aspiration","description":"Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69220","name":"Clean out mastoid cavity","description":"Debridement, mastoidectomy cavity, simple (eg, routine cleaning)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76529","name":"Echo exam of eye","description":"Ophthalmic ultrasonic foreign body localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74170","name":"Ct abd wo cntrst flwd cntrst","description":"Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58760","name":"Fimbrioplasty","description":"Fimbrioplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":525.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30450","name":"Revision of nose","description":"Rhinoplasty, secondary; major revision (nasal tip work and osteotomies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1327.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6693","name":"Lockingelbow forearm cntrbal","description":"Upper extremity addition, locking elbow, forearm counterbalance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1383.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5682","name":"Bk thigh lacer glut/ischia m","description":"Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6620","name":"Flexion/extension wrist unit","description":"Upper extremity addition, flexion/extension wrist unit, with or without friction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":150.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32402","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":433.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57268","name":"Repair of bowel bulge","description":"Repair of enterocele, vaginal approach (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":316.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51741","name":"Electro-uroflowmetry first","description":"Complex uroflowmetry (eg, calibrated electronic equipment)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82945","name":"Glucose other fluid","description":"Glucose, body fluid, other than blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6412","name":"Occlusive eye patch","description":"Eye patch, occlusive, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27345","name":"Removal of knee cyst","description":"Excision of synovial cyst of popliteal space (eg, bakers cyst)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25505","name":"Cltx rdl shft fx w/mnpj","description":"Closed treatment of radial shaft fracture; with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51100","name":"Drain bladder by needle","description":"Aspiration of bladder; by needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28150","name":"Removal of toe","description":"Phalangectomy, toe, each toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0278T","name":"Tempr","description":"Transcutaneous electrical modulation pain reprocessing (eg, scrambler therapy), each treatment session (includes placement of electrodes)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0650","name":"Pneuma compresor non-segment","description":"Pneumatic compressor, non-segmental home model","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6647","name":"Shoulder lock actuator","description":"Upper extremity addition, shoulder lock mechanism, body powered actuator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99496","name":"Transj care mgmt high f2f 7d","description":"Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge high level of medical decision making during the service period face-to-face visit, within 7 calenda","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43210","name":"Egd esophagogastrc fndoplsty","description":"Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58720","name":"Removal of ovary/tube(s)","description":"Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82043","name":"Ur albumin quantitative","description":"Albumin; urine (eg, microalbumin), quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83887","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21249","name":"Reconstruction of jaw","description":"Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5658","name":"Socket insert above knee","description":"Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5331","name":"Hip disart canadian sach ft","description":"Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78102","name":"Bone marrow imaging ltd","description":"Bone marrow imaging; limited area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":137.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15781","name":"Dermabrasion segmental face","description":"Dermabrasion; segmental, face","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":345.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87169","name":"Macroscopic exam parasite","description":"Macroscopic examination; parasite","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23620","name":"Cltx gr hmrl tbrs fx wo mnpj","description":"Closed treatment of greater humeral tuberosity fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77402","name":"Radiation tx delivery lvl 1","description":"Radiation treatment delivery; level 1 (eg, single-electron field, multiple-electron fields, or 2d photons), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6453","name":"Self-adher band w <3in/yd","description":"Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38100","name":"Removal of spleen total","description":"Splenectomy; total (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":775.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31654","name":"Bronch ebus ivntj perph les","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (list separately in addition to code for primary procedure[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17261","name":"Dstrj mal les t/a/l .6-1.0cm","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":89.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00934","name":"Anes rad amp penis ingun lym","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23600","name":"Cltx prox humrl fx w/o mnpj","description":"Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0498","name":"Chemo extend iv infus w/pump","description":"Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":142.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83825","name":"Assay of mercury","description":"Mercury, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9488","name":"Remote e/m est. pt 25mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of modera","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74740","name":"X-ray female genital tract","description":"Hysterosalpingography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"C1758","name":"Catheter, ureteral","description":"Catheter, ureteral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84140","name":"Assay of pregnenolone","description":"Pregnenolone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92615","name":"Laryngoscopic sensory i&r","description":"Flexible endoscopic evaluation, laryngeal sensory testing by cine or video recording; interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35875","name":"Removal of clot in graft","description":"Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25246","name":"Injection for wrist x-ray","description":"Injection procedure for wrist arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3808","name":"Whfo, rigid w/o joints","description":"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":343.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15786","name":"Abrasion lesion single","description":"Abrasion; single lesion (eg, keratosis, scar)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":148.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1945","name":"Afo molded plas rig ant tib","description":"Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3510","name":"Orthopedic shoe add rub insl","description":"Orthopedic shoe addition, insole, rubber","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7018","name":"Water distilled w/nebulizer","description":"Water, distilled, used with large volume nebulizer, 1000 ml","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33768","name":"Anast cavopulm sec sup v/c","description":"Anastomosis, cavopulmonary, second superior vena cava (list separately in addition to primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":363.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64448","name":"Njx aa&/strd fem nrv nfs img","description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90876","name":"Psychophysiological therapy","description":"Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27305","name":"Incise thigh tendon & fascia","description":"Fasciotomy, iliotibial (tenotomy), open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":404.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32672","name":"Thoracoscopy for lvrs","description":"Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (lvrs), unilateral includes any pleural procedure, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4259","name":"Lancets per box","description":"Lancets, per box of 100","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","KL","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01632","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5990","name":"User adjustable heel height","description":"Addition to lower extremity prosthesis, user adjustable heel height","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3450","name":"Shoe heel sach cushion type","description":"Heel, sach cushion type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93464","name":"Exercise w/hemodynamic meas","description":"Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33770","name":"Rpr tga w/o surg enlgmnt vsd","description":"Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; without surgical enlargement of ventricular septal defect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92553","name":"Audiometry air & bone","description":"Pure tone audiometry (threshold); air and bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50430","name":"Njx px nfrosgrm &/urtrgrm","description":"Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":456.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70010","name":"Contrast x-ray of brain","description":"Myelography, posterior fossa, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37722","name":"Lig div&strpg long saph vein","description":"Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4657","name":"Syringe w/wo needle","description":"Syringe, with or without needle, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27222","name":"Treat hip socket fracture","description":"Closed treatment of acetabulum (hip socket) fracture(s); with manipulation, with or without skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":822.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31276","name":"Nsl/sins ndsc frnt tiss rmvl","description":"Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","name":"Lipid panel","description":"Lipid panel this panel must include the following: cholesterol, serum, total (82465) lipoprotein, direct measurement, high density cholesterol (hdl cholesterol) (83718) triglycerides (84478)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22208","name":"Incis spine 3 column adl seg","description":"Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); each additional vertebral segment (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54220","name":"Irrg crpra cavrnosa priapism","description":"Irrigation of corpora cavernosa for priapism","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31233","name":"Nsl/sins ndsc dx max sinusc","description":"Nasal/sinus endoscopy, diagnostic; with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":195.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33978","name":"Remove ventricular device","description":"Removal of ventricular assist device; extracorporeal, biventricular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59100","name":"Remove uterus lesion","description":"Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73020","name":"X-ray exam of shoulder","description":"Radiologic examination, shoulder; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0001","name":"Alcohol and/or drug assess","description":"Alcohol and/or drug assessment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6252","name":"Absorpt drg >16 <=48 w/o bdr","description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17284","name":"Dstr mal ls f/e/e/n/l/m3.1-4","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86744","name":"Nocardia antibody","description":"Antibody; nocardia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89331","name":"Retrograde ejaculation anal","description":"Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61514","name":"Crnec treph exc brn abs sttl","description":"Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess, supratentorial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1744.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22548","name":"Arthrd ant toral/xoral c1-c2","description":"Arthrodesis, anterior transoral or extraoral technique, clivus-c1-c2 (atlas-axis), with or without excision of odontoid process","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22595","name":"Arthrd pst tq atlas-axis","description":"Arthrodesis, posterior technique, atlas-axis (c1-c2)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31629","name":"Bronchoscopy/needle bx each","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0114","name":"Fern test","description":"Fern test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0083","name":"Care man h v ext pt 45 m","description":"Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiarys home, domiciliary, rest home, assisted living and/or nursing facility)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65285","name":"Repair of eye wound","description":"Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":666.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95867","name":"Ndl emg cranial nrv musc uni","description":"Needle electromyography; cranial nerve supplied muscle(s), unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":72.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44602","name":"Suture small intestine","description":"Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1173.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31420","name":"Epiglottidectomy","description":"Epiglottidectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":616.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3924","name":"Hfo without joints pre ots","description":"Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55520","name":"Removal of sperm cord lesion","description":"Excision of lesion of spermatic cord (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97003","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":49.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23125","name":"Claviculectomy total","description":"Claviculectomy; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":599.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70496","name":"Ct angiography head","description":"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88142","name":"Cytopath c/v thin layer","description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52648","name":"Laser surgery of prostate","description":"Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1352.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74174","name":"Cta abd&plvs w/contrast","description":"Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":319.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28046","name":"Resect foot/toe tumor < 3 cm","description":"Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4391","name":"Urinary pouch w ex wear barr","description":"Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00952","name":"Anes vag px hystsc&/hsg","description":"Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31527","name":"Laryngoscopy for treatment","description":"Laryngoscopy direct, with or without tracheoscopy; with insertion of obturator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2020","name":"Kafo dbl solid stirrup band/","description":"Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar ak orthosis), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":591.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62161","name":"Dissect brain w/scope","description":"Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1376.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28175","name":"Resect phalanx of toe tumor","description":"Radical resection of tumor; phalanx of toe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":373.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37650","name":"Ligation of femoral vein","description":"Ligation of femoral vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":402.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82638","name":"Assay of dibucaine number","description":"Dibucaine number","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96171","name":"Hlth bhv ivntj fam w/o pt ea","description":"Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27323","name":"Biopsy thigh soft tissues","description":"Biopsy, soft tissue of thigh or knee area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":225.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27550","name":"Treat knee dislocation","description":"Closed treatment of knee dislocation; without anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50930","name":"Closure ureter/bowel fistula","description":"Closure of ureterovisceral fistula (including visceral repair)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01464","name":"Anes arthrs px ankle&/foot","description":"Anesthesia for arthroscopic procedures of ankle and/or foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89160","name":"Exam feces for meat fibers","description":"Meat fibers, feces","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64837","name":"Repair nerve add-on","description":"Suture of each additional nerve, hand or foot (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67914","name":"Repair eyelid defect","description":"Repair of ectropion; suture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":294.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42000","name":"Drainage mouth roof lesion","description":"Drainage of abscess of palate, uvula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":121.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45386","name":"Colonoscopy w/balloon dilat","description":"Colonoscopy, flexible; with transendoscopic balloon dilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93317","name":"Echo transesophageal","description":"Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01430","name":"Anes px veins knee&pop nos","description":"Anesthesia for procedures on veins of knee and popliteal area; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1810","name":"Ko elastic with joints","description":"Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20920","name":"Removal of fascia for graft","description":"Fascia lata graft; by stripper","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31400","name":"Revision of larynx","description":"Arytenoidectomy or arytenoidopexy, external approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":735.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70355","name":"Panoramic x-ray of jaws","description":"Orthopantogram (eg, panoramic x-ray)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95984","name":"Alys brn npgt prgrmg addl 15","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24650","name":"Cltx rdl head/nck fx wo mnpj","description":"Closed treatment of radial head or neck fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":217.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43200","name":"Esophagoscopy flexible brush","description":"Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":187.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24516","name":"Tx humrl shaft fx imed implt","description":"Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":724.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64463","name":"Pvb thoracic cont infusion","description":"Paravertebral block (pvb) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87495","name":"Cytomeg dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); cytomegalovirus, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27700","name":"Revision of ankle joint","description":"Arthroplasty, ankle;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22854","name":"Insj biomechanical device","description":"Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrod","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":301.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A8002","name":"Soft protect helmet custom","description":"Helmet, protective, soft, custom fabricated, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27098","name":"Transfer tendon to pelvis","description":"Transfer, adductor to ischium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42335","name":"Removal of salivary stone","description":"Sialolithotomy; submandibular (submaxillary), complicated, intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99454","name":"Rem mntr physiol param 16-30","description":"Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 16-30 days in a 30-day period","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61537","name":"Removal of brain tissue","description":"Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, without electrocorticography during surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2271.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82610","name":"Cystatin c","description":"Cystatin c","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81420","name":"Fetal chrmoml aneuploidy","description":"Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy x) genomic sequence analysis panel, circulating cell-free fetal dna in maternal blood, must include analysis of chromosomes 13, 18, and 21","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":379.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P3001","name":"Screening pap smear by phys","description":"Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33322","name":"Repair major blood vessel(s)","description":"Suture repair of aorta or great vessels; with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88333","name":"Path consltj surg cyto xm 1","description":"Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75880","name":"Vein x-ray eye socket","description":"Venography, orbital, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30110","name":"Removal of nose polyp(s)","description":"Excision, nasal polyp(s), simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92526","name":"Oral function therapy","description":"Treatment of swallowing dysfunction and/or oral function for feeding","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91035","name":"G-esoph reflx tst w/electrod","description":"Esophagus, gastroesophageal reflux test; with mucosal attached telemetry ph electrode placement, recording, analysis and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35585","name":"Vein byp fem-tibial peroneal","description":"In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86000","name":"Agglutinins febrile antigen","description":"Agglutinins, febrile (eg, brucella, francisella, murine typhus, q fever, rocky mountain spotted fever, scrub typhus), each antigen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87651","name":"Strep a dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); streptococcus, group a, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00922","name":"Anes px male gent sem ves","description":"Anesthesia for procedures on male genitalia (including open urethral procedures); seminal vesicles","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73040","name":"Contrast x-ray of shoulder","description":"Radiologic examination, shoulder, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":95.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96160","name":"Pt-focused hlth risk assmt","description":"Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95805","name":"Multiple sleep latency test","description":"Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54150","name":"Circumcision w/regionl block","description":"Circumcision, using clamp or other device with regional dorsal penile or ring block","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2110","name":"Spherocylinder 4.25d/over 6d","description":"Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61708","name":"Revise circulation to head","description":"Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial electrothrombosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2341.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90960","name":"Esrd srv 4 visits p mo 20+","description":"End-stage renal disease (esrd) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V5008","name":"Hearing screening","description":"Hearing screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2364","name":"U1nonsealed leadacid battery","description":"Power wheelchair accessory, u-1 non-sealed lead acid battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78191","name":"Platelet survival study","description":"Platelet survival study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33670","name":"Repair of heart chambers","description":"Repair of complete atrioventricular canal, with or without prosthetic valve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3912","name":"Hfo flexion glove pre ots","description":"Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27810","name":"Treatment of ankle fracture","description":"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86334","name":"Immunofix e-phoresis serum","description":"Immunofixation electrophoresis; serum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83894","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15331","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"91301","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0405","name":"Ekg interpret & report preve","description":"Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0217T","name":"Njx paravert w/us lumb/sac","description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; second level (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84577","name":"Assay of feces/urobilinogen","description":"Urobilinogen, feces, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51960","name":"Revision of bladder & bowel","description":"Enterocystoplasty, including intestinal anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33286","name":"Rmvl subq car rhythm mntr","description":"Removal, subcutaneous cardiac rhythm monitor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25105","name":"Remove wrist joint lining","description":"Arthrotomy, wrist joint; with synovectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64616","name":"Chemodenerv musc neck dyston","description":"Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14301","name":"Tis trnfr any 30.1-60 sq cm","description":"Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88249","name":"Chromosome analysis 100","description":"Chromosome analysis for breakage syndromes; score 100 cells, clastogen stress (eg, diepoxybutane, mitomycin c, ionizing radiation, uv radiation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27054","name":"Removal of hip joint lining","description":"Arthrotomy with synovectomy, hip joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":578.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67975","name":"Reconstruction of eyelid","description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33230","name":"Insrt pulse gen w/dual leads","description":"Insertion of implantable defibrillator pulse generator only; with existing dual leads","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29000","name":"Appl halo type body cast","description":"Application of halo type body cast (see 20661-20663 for insertion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":290.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86832","name":"Hla class i high defin qual","description":"Antibody to human leukocyte antigens (hla), solid phase assays (eg, microspheres or beads, elisa, flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), hla class i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34501","name":"Repair valve femoral vein","description":"Valvuloplasty, femoral vein","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":482.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38760","name":"Remove groin lymph nodes","description":"Inguinofemoral lymphadenectomy, superficial, including cloquets node (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45121","name":"Removal of rectum and colon","description":"Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with subtotal or total colectomy, with multiple biopsies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1462.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76873","name":"Echograp trans r pros study","description":"Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33920","name":"Repair pulmonary atresia","description":"Repair of pulmonary atresia with ventricular septal defect, by construction or replacement of conduit from right or left ventricle to pulmonary artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2785","name":"Drop lock retainer each","description":"Addition to lower extremity orthosis, drop lock retainer, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29847","name":"Wrist arthroscopy/surgery","description":"Arthroscopy, wrist, surgical; internal fixation for fracture or instability","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84403","name":"Assay of total testosterone","description":"Testosterone; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36465","name":"Njx noncmpnd sclrsnt 1 vein","description":"Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68500","name":"Removal of tear gland","description":"Excision of lacrimal gland (dacryoadenectomy), except for tumor; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":609.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78122","name":"Whl bld volume determination","description":"Whole blood volume determination, including separate measurement of plasma volume and red cell volume (radiopharmaceutical volume-dilution technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1806","name":"Sps wrist device","description":"Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26080","name":"Explore/treat finger joint","description":"Arthrotomy, with exploration, drainage, or removal of loose or foreign body; interphalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":326.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95912","name":"Nrv cndj test 11-12 studies","description":"Nerve conduction studies; 11-12 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82600","name":"Assay of cyanide","description":"Cyanide","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76511","name":"Oph us dx quan a-scan only","description":"Ophthalmic ultrasound, diagnostic; quantitative a-scan only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":47.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95983","name":"Alys brn npgt prgrmg 15 min","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31081","name":"Removal of frontal sinus","description":"Sinusotomy frontal; obliterative, without osteoplastic flap, coronal incision (includes ablation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51729","name":"Cystometrogram w/vp&up","description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":301.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77373","name":"Strtctc bdy rad ther tx dlvr","description":"Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":976.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"U0001","name":"2019-ncov diagnostic p","description":"Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0174T","name":"Cad cxr with interp","description":"Computer-aided detection (cad) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation (list s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64420","name":"Njx aa&/strd ntrcost nrv 1","description":"Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90867","name":"Tcranial magn stim tx plan","description":"Therapeutic repetitive transcranial magnetic stimulation (tms) treatment; initial, including cortical mapping, motor threshold determination, delivery and management","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92608","name":"Ex for speech device rx addl","description":"Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9484","name":"Remote e/m new pt 45mins","description":"Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":55.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00350","name":"Anes px major vsl neck nos","description":"Anesthesia for procedures on major vessels of neck; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13153","name":"Cmplx rpr e/n/e/l addl 5cm/<","description":"Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2330","name":"Lacer molded to patient mode","description":"Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":244.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0236","name":"Pump for water circulating p","description":"Pump for water circulating pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45505","name":"Repair of rectum","description":"Proctoplasty; for prolapse of mucous membrane","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":475.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1810","name":"Adjust knee ext & flex dev","description":"Dynamic adjustable knee extension and flexion device, includes soft interface material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93285","name":"Prgrmg dev eval scrms ip","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; subcutaneous cardiac rhythm mon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30560","name":"Lysis intranasal synechia","description":"Lysis intranasal synechia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":219.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32855","name":"Prepare donor lung single","description":"Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":157.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6260","name":"Wound cleanser any type/size","description":"Wound cleansers, any type, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40800","name":"Drainage of mouth lesion","description":"Drainage of abscess, cyst, hematoma, vestibule of mouth; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36455","name":"Bld exchange truj oth thn nb","description":"Exchange transfusion, blood; other than newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4707","name":"Bicarbonate conc pow per pac","description":"Bicarbonate concentrate, powder, for hemodialysis, per packet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77412","name":"Radiation tx delivery lvl 3","description":"Radiation treatment delivery; level 3, multiple isocenters with photon therapy (eg, 2d, 3d, or imrt) or a single-isocenter photon therapy (eg, 3d or imrt) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5704","name":"Custom shape cover bk","description":"Custom shaped protective cover, below knee","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":282.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27062","name":"Remove femur lesion/bursa","description":"Excision; trochanteric bursa or calcification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92133","name":"Cptrzd oph dx img pst sgm on","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), posterior segment, with interpretation and report, unilateral or bilateral; optic nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59821","name":"Treatment of miscarriage","description":"Treatment of missed abortion, completed surgically; second trimester","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36581","name":"Replace tunneled cv cath","description":"Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":650.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31085","name":"Removal of frontal sinus","description":"Sinusotomy frontal; obliterative, with osteoplastic flap, coronal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69401","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":69.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77012","name":"Ct scan for needle biopsy","description":"Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19102","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59015","name":"Chorion biopsy","description":"Chorionic villus sampling, any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":136.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95070","name":"Inhlj brncl challenge tstg","description":"Inhalation bronchial challenge testing (not including necessary pulmonary function tests), with histamine, methacholine, or similar compounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15050","name":"Pinch graft up to 2 cm diam","description":"Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":371.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96112","name":"Devel tst phys/qhp 1st hr","description":"Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77012","name":"Ct scan for needle biopsy","description":"Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33955","name":"Ecmo/ecls insj ctr cannula","description":"Extracorporeal membrane oxygenation (ecmo)/extracorporeal life support (ecls) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":724.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93297","name":"Rem interrog dev eval icpms","description":"Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other quali","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23350","name":"Injection for shoulder x-ray","description":"Injection procedure for shoulder arthrography or enhanced ct/mri shoulder arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33504","name":"Coronary artery graft","description":"Repair of anomalous coronary artery from pulmonary artery origin; by graft, with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0402","name":"Initial preventive exam","description":"Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97168","name":"Ot re-eval est plan care","description":"Re-evaluation of occupational therapy established plan of care, requiring these components: an assessment of changes in patient functional or medical status with revised plan of care; an update to the initial occupational profile to reflect changes in condition or environment that affect future inte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8615","name":"Coch implant headset replace","description":"Headset/headpiece for use with cochlear implant device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42405","name":"Biopsy of salivary gland","description":"Biopsy of salivary gland; incisional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":233.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78102","name":"Bone marrow imaging ltd","description":"Bone marrow imaging; limited area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7402","name":"Add ue prost s/d ultlite mat","description":"Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":180.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4400","name":"Ostomy irrigation set","description":"Ostomy irrigation set","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33256","name":"Ablate atria w/bypass exten","description":"Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); with cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1679.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53405","name":"Revise urethra stage 2","description":"Urethroplasty; second stage (formation of urethra), including urinary diversion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67906","name":"Repair eyelid defect","description":"Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":303.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53025","name":"Incision of urethra","description":"Meatotomy, cutting of meatus (separate procedure); infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8690","name":"Aud osseo dev, int/ext comp","description":"Auditory osseointegrated device, includes all internal and external components","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94617","name":"Exercise tst brncspsm w/ecg","description":"Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic recording(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26560","name":"Repair of web finger","description":"Repair of syndactyly (web finger) each web space; with skin flaps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31293","name":"Nsl/sins ndsc med&inf dcmprn","description":"Nasal/sinus endoscopy, surgical, with orbital decompression; medial and inferior wall","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":805.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5505","name":"Init ak ischal plstr direct","description":"Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":863.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92082","name":"Intermediate visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on goldmann perimeter, or semiquantitative, automated suprathreshold screening program, humphrey suprathreshold automatic diagnostic test, octopus program 33)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00145","name":"Anes px eye vitreortnl surg","description":"Anesthesia for procedures on eye; vitreoretinal surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29000","name":"Appl halo type body cast","description":"Application of halo type body cast (see 20661-20663 for insertion)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36005","name":"Injection ext venography","description":"Injection procedure for extremity venography (including introduction of needle or intracatheter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":240.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99607","name":"Mtms by pharm addl 15 min","description":"Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2080","name":"Hkafo unilat torsion cable","description":"Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78230","name":"Salivary gland imaging","description":"Salivary gland imaging;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29105","name":"Application long arm splint","description":"Application of long arm splint (shoulder to hand)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64782","name":"Remove limb nerve lesion","description":"Excision of neuroma; hand or foot, except digital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37788","name":"Revascularization penis","description":"Penile revascularization, artery, with or without vein graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1023.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29435","name":"Appl patllr tdn bearing cast","description":"Application of patellar tendon bearing (ptb) cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0452","name":"Tlso flex custom fab thoraci","description":"Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6690","name":"Frame typ sock interscap-tho","description":"Upper extremity addition, frame type socket, interscapular-thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33471","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1148.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87152","name":"Culture type pulse field gel","description":"Culture, typing; identification by pulse field gel typing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4375","name":"Drainable plastic pch w fcpl","description":"Ostomy pouch, drainable, with faceplate attached, plastic, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73700","name":"Ct lower extremity w/o dye","description":"Computed tomography, lower extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93875","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65110","name":"Removal of eye","description":"Exenteration of orbit (does not include skin graft), removal of orbital contents; only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":766.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86905","name":"Blood typing rbc antigens","description":"Blood typing, serologic; rbc antigens, other than abo or rh (d), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49616","name":"Rpr aa hrn rcr 3-10 ncr/strn","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":688.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70482","name":"Ct orbit/ear/fossa w/o&w/dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64613","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93880","name":"Extracranial bilat study","description":"Duplex scan of extracranial arteries; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54056","name":"Cryosurgery penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86723","name":"Listeria monocytogenes","description":"Antibody; listeria monocytogenes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86413","name":"Sars-cov-2 antb quantitative","description":"Severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) antibody, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73080","name":"X-ray exam of elbow","description":"Radiologic examination, elbow; complete, minimum of 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78582","name":"Lung ventilat&perfus imaging","description":"Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":270.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86316","name":"Immunoassay tumor other","description":"Immunoassay for tumor antigen, other antigen, quantitative (eg, ca 50, 72-4, 549), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2601","name":"Gen w/c cushion wdth < 22 in","description":"General use wheelchair seat cushion, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1640","name":"Pelv band/spread bar thigh c","description":"Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33440","name":"Rplcmt a-valve tlcj autol pv","description":"Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (ross-konno procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2025","name":"Dis site tele svcs rhc/fqhc","description":"Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0144","name":"Scr c/v cyto,thinlayer,rescr","description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93722","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1847","name":"Ko dbl upright w/air pre cst","description":"Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88312","name":"Special stains group 1","description":"Special stain including interpretation and report; group i for microorganisms (eg, acid fast, methenamine silver)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27424","name":"Revision/removal of kneecap","description":"Reconstruction of dislocating patella; with patellectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0128","name":"Corf skilled nursing service","description":"Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0625","name":"Lo flex l1-below l5 pre ots","description":"Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25652","name":"Optx ulnar styloid fracture","description":"Open treatment of ulnar styloid fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0522T","name":"Prgrmg dev eval wcs ip","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, wireless cardiac stimulator for left ventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27886","name":"Amputation follow-up surgery","description":"Amputation, leg, through tibia and fibula; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27105","name":"Transfer of spinal muscle","description":"Transfer paraspinal muscle to hip (includes fascial or tendon extension graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":732.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85007","name":"Bl smear w/diff wbc count","description":"Blood count; blood smear, microscopic examination with manual differential wbc count","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36224","name":"Place cath carotd art","description":"Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1697.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0247T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":687.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83051","name":"Hemoglobin plasma","description":"Hemoglobin; plasma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96121","name":"Nubhvl xm phy/qhp ea addl hr","description":"Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2083","name":"Visit esketamine, > 56m","description":"Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of  greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24357","name":"Repair elbow perc","description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfers elbow); percutaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37214","name":"Cessj therapy cath removal","description":"Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0154A","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85660","name":"Rbc sickle cell test","description":"Sickling of rbc, reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25929","name":"Amputation follow-up surgery","description":"Transmetacarpal amputation; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":503.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35450","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.31,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77422","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88125","name":"Forensic cytopathology","description":"Cytopathology, forensic (eg, sperm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4384","name":"Ostomy faceplt/silicone ring","description":"Ostomy faceplate equivalent, silicone ring, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11406","name":"Exc tr-ext b9+marg >4.0 cm","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89329","name":"Sperm evaluation test","description":"Sperm evaluation; hamster penetration test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22212","name":"Incis 1 vertebral seg thorac","description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88280","name":"Chromosome karyotype study","description":"Chromosome analysis; additional karyotypes, each study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23125","name":"Claviculectomy total","description":"Claviculectomy; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1390","name":"Oxygen concentrator","description":"Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83516","name":"Immunoassay nonantibody","description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43405","name":"Ligate/staple esophagus","description":"Ligation or stapling at gastroesophageal junction for pre-existing esophageal perforation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47538","name":"Perq plmt bile duct stent","description":"Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; existing ac","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69670","name":"Remove mastoid air cells","description":"Mastoid obliteration (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75833","name":"Vein x-ray kidneys","description":"Venography, renal, bilateral, selective, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94642","name":"Aerosol inhalation treatment","description":"Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49904","name":"Omental flap extra-abdom","description":"Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1141.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6457","name":"Tubular dressing","description":"Tubular dressing with or without elastic, any width, per linear yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20962","name":"Other bone graft microvasc","description":"Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99408","name":"Audit/dast 15-30 min","description":"Alcohol and/or substance (other than tobacco) abuse structured screening (eg, audit, dast), and brief intervention (sbi) services; 15 to 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40814","name":"Excise/repair mouth lesion","description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":292.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69650","name":"Stapes mobilization","description":"Stapes mobilization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":646.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40701","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; primary bilateral, 1-stage procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":957.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93724","name":"Elec alys antitchycar pm sys","description":"Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11308","name":"Shave skin lesion >2.0 cm","description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":93.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73502","name":"X-ray exam hip uni 2-3 views","description":"Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4570","name":"Splint","description":"Splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0440T","name":"Abltj perc uxtr/perph nrv","description":"Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":172.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20912","name":"Remove cartilage for graft","description":"Cartilage graft; nasal septum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":389.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24105","name":"Excision olecranon bursa","description":"Excision, olecranon bursa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":295.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67923","name":"Repair eyelid defect","description":"Repair of entropion; excision tarsal wedge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69300","name":"Revise external ear","description":"Otoplasty, protruding ear, with or without size reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57268","name":"Repair of bowel bulge","description":"Repair of enterocele, vaginal approach (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90947","name":"Dialysis repeated eval","description":"Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated evaluations by a physician or other qualified health care professional, with or without substantial revision of dialysis prescription","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64640","name":"Injection treatment of nerve","description":"Destruction by neurolytic agent; other peripheral nerve or branch","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":197.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53215","name":"Removal of urethra","description":"Urethrectomy, total, including cystostomy; male","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":752.27,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65782","name":"Ocular reconst transplant","description":"Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1171","name":"Wheelchair amputee w/o leg r","description":"Amputee wheelchair, fixed full length arms, without footrests or legrest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76376","name":"3d render w/intrp postproces","description":"3d rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54250","name":"Nctrnl pen tmscn&/rgdity tst","description":"Nocturnal penile tumescence and/or rigidity test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65780","name":"Ocular reconst transplant","description":"Ocular surface reconstruction; amniotic membrane transplantation, multiple layers","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":401.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82725","name":"Assay of blood fatty acids","description":"Fatty acids, nonesterified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28285","name":"Repair of hammertoe","description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78831","name":"Rp loclzj tum spect 2 areas","description":"Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect), minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilati","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32609","name":"Thoracoscopy w/bx pleura","description":"Thoracoscopy; with biopsy(ies) of pleura","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26340","name":"Manipulate finger w/anesth","description":"Manipulation, finger joint, under anesthesia, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73615","name":"Contrast x-ray of ankle","description":"Radiologic examination, ankle, arthrography, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58555","name":"Hysteroscopy dx sep proc","description":"Hysteroscopy, diagnostic (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00532","name":"Anes access ctr venous crcj","description":"Anesthesia for access to central venous circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26740","name":"Treat finger fracture each","description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50782","name":"Reimplant ureter in bladder","description":"Ureteroneocystostomy; anastomosis of duplicated ureter to bladder","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77071","name":"Mnl appl strs jt radiography","description":"Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69540","name":"Excision aural polyp","description":"Excision aural polyp","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5500","name":"Diab shoe for density insert","description":"For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26540","name":"Repair hand joint","description":"Repair of collateral ligament, metacarpophalangeal or interphalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":557.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92083","name":"Extended visual field xm","description":"Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 deg, or quantitative, automated threshold perimetry, octopus program g-1, 32 or 42, hump","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00848","name":"Anes iper px pel exentration","description":"Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; pelvic exenteration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31648","name":"Bronchial valve remov init","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78216","name":"Lvr&spleen img w/vasc flow","description":"Liver and spleen imaging; with vascular flow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1030","name":"Lumbar bolster pad","description":"Addition to ctlso or scoliosis orthosis, lumbar bolster pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35572","name":"Harvest femoropopliteal vein","description":"Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49402","name":"Remove foreign body adbomen","description":"Removal of peritoneal foreign body from peritoneal cavity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":710.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26530","name":"Revise knuckle joint","description":"Arthroplasty, metacarpophalangeal joint; each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":450.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86161","name":"Complement/function activity","description":"Complement; functional activity, each component","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82190","name":"Atomic absorption","description":"Atomic absorption spectroscopy, each analyte","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4928","name":"Surgical mask","description":"Surgical mask, per 20","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38241","name":"Transplt autol hct/donor","description":"Hematopoietic progenitor cell (hpc); autologous transplantation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":105.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0494","name":"Emr hd pmp elec/combo, rep","description":"Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4306","name":"Drug delivery system <=50 ml","description":"Disposable drug delivery system, flow rate of less than 50 ml per hour","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33886","name":"Delayed plmt dstl xtn prosth","description":"Delayed placement of distal extension prosthesis(es) from the level of the left subclavian artery to the celiac artery, after endovascular repair of descending thoracic aorta, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological superv","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43193","name":"Esophagoscp rig trnso biopsy","description":"Esophagoscopy, rigid, transoral; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40520","name":"Partial excision of lip","description":"Excision of lip; v-excision with primary direct linear closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":386.2,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43288","name":"Esphg thrsc moblj","description":"Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, th","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3136.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61517","name":"Implt brn intrcv chemotx agt","description":"Implantation of brain intracavitary chemotherapy agent (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":81.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27510","name":"Treatment of thigh fracture","description":"Closed treatment of femoral fracture, distal end, medial or lateral condyle, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":574.49,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5120","name":"Skin barrier, wipe or swab","description":"Skin barrier, wipes or swabs, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","AU","AV","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4624","name":"Tracheal suction tube","description":"Tracheal suction catheter, any type other than closed system, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39000","name":"Exploration of chest","description":"Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; cervical approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":424.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10021","name":"Fna bx w/o img gdn 1st les","description":"Fine needle aspiration biopsy, without imaging guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86304","name":"Immunoassay tumor ca 125","description":"Immunoassay for tumor antigen, quantitative; ca 125","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5724","name":"Knee-shin exo fluid swing ph","description":"Addition, exoskeletal knee-shin system, single axis, fluid swing phase control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25110","name":"Remove wrist tendon lesion","description":"Excision, lesion of tendon sheath, forearm and/or wrist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41153","name":"Tongue mouth neck surgery","description":"Glossectomy; composite procedure with resection floor of mouth, with suprahyoid neck dissection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1856.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45380","name":"Colonoscopy and biopsy","description":"Colonoscopy, flexible; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":327.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0489","name":"Pwr pck base combo vad, rep","description":"Power pack base for use with electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7916.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28340","name":"Resect enlarged toe tissue","description":"Reconstruction, toe, macrodactyly; soft tissue resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":458.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0168","name":"Heavyduty/wide commode chair","description":"Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4083","name":"Enteral stomach tube levine","description":"Stomach tube - levine type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41874","name":"Alveoloplasty each quadrant","description":"Alveoloplasty, each quadrant (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":300.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4422","name":"Ost pouch absorbent material","description":"Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0513","name":"Prolong prev svcs, first 30m","description":"Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2192","name":"Pelvic band & belt thigh fla","description":"Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99254","name":"Ip/obs cnsltj new/est mod 60","description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. when using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35475","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1246.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54900","name":"Fusion of spermatic ducts","description":"Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4364","name":"Adhesive, liquid or equal","description":"Adhesive, liquid or equal, any type, per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63090","name":"Remove vert body dcmprn lmbr","description":"Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; single segment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1712.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75557","name":"Cardiac mri for morph","description":"Cardiac magnetic resonance imaging for morphology and function without contrast material;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9986","name":"Remote e/m est. pt 40mins","description":"Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88387","name":"Macroscopic xm dsj&prep tiss","description":"Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies), each tissue preparation (eg, a single lymph node)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46030","name":"Removal anal seton oth mrk","description":"Removal of anal seton, other marker","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86825","name":"Hla x-math non-cytotoxic","description":"Human leukocyte antigen (hla) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82175","name":"Assay of arsenic","description":"Arsenic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6222","name":"Gauze <=16 in no w/sal w/o b","description":"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61700","name":"Brain aneurysm repr simple","description":"Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73722","name":"Mri joint of lwr extr w/dye","description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4630","name":"Repl bat t.e.n.s. own by pt","description":"Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37182","name":"Insert hepatic shunt (tips)","description":"Insertion of transvenous intrahepatic portosystemic shunt(s) (tips) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":649.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46748","name":"Repair of cloacal anomaly","description":"Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach; with vaginal lengthening by intestinal graft or pedicle flaps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3561.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93462","name":"L hrt cath trnsptl puncture","description":"Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7008","name":"Pediatric electric hand","description":"Electric hand, switch or myoelectric, controlled, pediatric","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3049.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97802","name":"Medical nutrition indiv in","description":"Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15201","name":"Fth/gft fr trnk each addl","description":"Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93292","name":"Wcd device interrogate","description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4709","name":"Acid conc sol per gallon","description":"Acid concentrate, solution, for hemodialysis, per gallon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0564T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61564","name":"Excision of skull tumor","description":"Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); with optic nerve decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11423","name":"Exc h-f-nk-sp b9+marg 2.1-3","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82272","name":"Occult bld feces 1-3 tests","description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58267","name":"Vag hyst w/urinary repair","description":"Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (marshall-marchetti-krantz type, pereyra type) with or without endoscopic control","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":683.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24075","name":"Exc arm/elbow les sc < 3 cm","description":"Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":431.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22220","name":"Osteot dsc ant 1 vrt sgm crv","description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4483","name":"Moisture exchanger","description":"Moisture exchanger, disposable, for use with invasive mechanical ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93320","name":"Doppler echo complete","description":"Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74230","name":"X-ray xm swlng funcj c+","description":"Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72200","name":"X-ray exam si joints","description":"Radiologic examination, sacroiliac joints; less than 3 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64462","name":"Pvb thoracic 2nd+ inj site","description":"Paravertebral block (pvb) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4455","name":"Adhesive remover per ounce","description":"Adhesive remover or solvent (for tape, cement or other adhesive), per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95874","name":"Guide nerv destr needle emg","description":"Needle electromyography for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31630","name":"Bronchoscopy dilate/fx repr","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12017","name":"Rpr fe/e/en/l/m 20.1-30.0 cm","description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2622","name":"Adj skin pro w/c cus wd<22in","description":"Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3260","name":"Ambulatory surgical boot eac","description":"Surgical boot/shoe, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44402","name":"Colonoscopy w/stent plcmt","description":"Colonoscopy through stoma; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":201.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43284","name":"Laps esophgl sphnctr agmntj","description":"Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":542.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24640","name":"Cltx rdl head sublxtj nrsemd","description":"Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":79.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43045","name":"Esophagotomy thrc rmvl fb","description":"Esophagotomy, thoracic approach, with removal of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97139","name":"Unlisted therapeutic px","description":"Unlisted therapeutic procedure (specify)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6450","name":"Lt compres band >=5in/yd","description":"Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66155","name":"Glaucoma surgery","description":"Fistulization of sclera for glaucoma; thermocauterization with iridectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12021","name":"Tx supfc wnd dehsn w/packing","description":"Treatment of superficial wound dehiscence; with packing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0519T","name":"Rmv&rplcmt pg wcs lv both","description":"Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; both components (battery and transmitter)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":748.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46917","name":"Laser surgery anal lesions","description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":326.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75820","name":"Vein x-ray arm/leg","description":"Venography, extremity, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":85.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99366","name":"Team conf w/pat by hc prof","description":"Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88155","name":"Cytopath c/v index add-on","description":"Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (list separately in addition to code[s] for other technical and interpretation services)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7031","name":"Replacement facemask interfa","description":"Face mask interface, replacement for full face mask, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6252","name":"Absorpt drg >16 <=48 w/o bdr","description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64448","name":"Njx aa&/strd fem nrv nfs img","description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3670","name":"So acro/clav can web pre ots","description":"Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64861","name":"Repair of arm nerves","description":"Suture of; brachial plexus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87641","name":"Mr-staph dna amp probe","description":"Infectious agent detection by nucleic acid (dna or rna); staphylococcus aureus, methicillin resistant, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86787","name":"Varicella-zoster antibody","description":"Antibody; varicella-zoster","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74178","name":"Ct abd&plv wo cntr flwd cntr","description":"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":289.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"60502","name":"Re-explore parathyroids","description":"Parathyroidectomy or exploration of parathyroid(s); re-exploration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6677","name":"Ue triple control harness","description":"Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78265","name":"Gstr emptg img sm bwl trnst","description":"Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":319.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31580","name":"Laryngoplasty laryngeal web","description":"Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2624","name":"Polishing artifical eye","description":"Polishing/resurfacing of ocular prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44126","name":"Enterectomy w/o taper cong","description":"Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; without tapering","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23660","name":"Optx acute shoulder dislc","description":"Open treatment of acute shoulder dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90959","name":"Esrd serv 1 vst p mo 12-19","description":"End-stage renal disease (esrd) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visit by a physician or other qualified health care professional per mont","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":209.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23455","name":"Repair shoulder capsule","description":"Capsulorrhaphy, anterior; with labral repair (eg, bankart procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":838.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34826","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26685","name":"Treat hand dislocation","description":"Open treatment of carpometacarpal dislocation, other than thumb; includes internal fixation, when performed, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5857","name":"Elec knee-shin swing only","description":"Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4201.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93528","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":446.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5925","name":"Above knee manual lock","description":"Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33414","name":"Repair of aortic valve","description":"Repair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1870.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44120","name":"Removal of small intestine","description":"Enterectomy, resection of small intestine; single resection and anastomosis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27784","name":"Treatment of fibula fracture","description":"Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":596.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28322","name":"Repair of metatarsals","description":"Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":643.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93976","name":"Vascular study","description":"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44310","name":"Ileostomy/jejunostomy","description":"Ileostomy or jejunostomy, non-tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":853.7,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49507","name":"Prp i/hern init block >5 yr","description":"Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":487.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15131","name":"Drm agrft t/a/l ea addl","description":"Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":63.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0415","name":"Open tx post pelvic fxcture","description":"Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":892.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61880","name":"Revise/remove neuroelectrode","description":"Revision or removal of intracranial neurostimulator electrodes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":518.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43846","name":"Gstr rstcv px shrt roux-en-y","description":"Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) roux-en-y gastroenterostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77065","name":"Dx mammo incl cad uni","description":"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6246","name":"Hydrogel drg >16<=48 in w/b","description":"Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85027","name":"Complete cbc automated","description":"Blood count; complete (cbc), automated (hgb, hct, rbc, wbc and platelet count)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71275","name":"Ct angiography chest","description":"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4155","name":"Ef incomplete/modular","description":"Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 un","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33522","name":"Cabg artery-vein five","description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":639.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77086","name":"Vrt fracture assmt via dxa","description":"Vertebral fracture assessment via dual-energy x-ray absorptiometry (dxa)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82979","name":"Assay rbc glutathione","description":"Glutathione reductase, rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54620","name":"Suspension of testis","description":"Fixation of contralateral testis (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29835","name":"Elbow arthroscopy/surgery","description":"Arthroscopy, elbow, surgical; synovectomy, partial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":428.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8043","name":"Upper facial prosthesis","description":"Upper facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2053.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92508","name":"Tx sp lang voice comm group","description":"Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93701","name":"Bioimpedance cv analysis","description":"Bioimpedance-derived physiologic cardiovascular analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48148","name":"Removal of pancreatic duct","description":"Excision of ampulla of vater","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11421","name":"Exc h-f-nk-sp b9+marg 0.6-1","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67515","name":"Inject/treat eye socket","description":"Injection of medication or other substance into tenons capsule","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98962","name":"Edu&trn pt slf-mgmt nqhp 5-8","description":"Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6010","name":"Collagen based wound filler","description":"Collagen based wound filler, dry form, sterile, per gram of collagen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00864","name":"Anes xtrprt lwr abd tot cstc","description":"Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; total cystectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86328","name":"Ia nfct ab sarscov2 covid19","description":"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85018","name":"Hemoglobin","description":"Blood count; hemoglobin (hgb)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35626","name":"Bpg aor-subcla/innom/carotid","description":"Bypass graft, with other than vein; aortosubclavian, aortoinnominate, or aortocarotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47360","name":"Repair liver wound","description":"Management of liver hemorrhage; complex suture of liver wound or injury, with or without hepatic artery ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1575.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6530","name":"Compression stocking bk18-30","description":"Gradient compression stocking, below knee, 18-30 mmhg, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0468","name":"Tlso rig fram pelvic pre cst","description":"Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48120","name":"Removal of pancreas lesion","description":"Excision of lesion of pancreas (eg, cyst, adenoma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":917.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29130","name":"Appl finger splint static","description":"Application of finger splint; static","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22510","name":"Perq cervicothoracic inject","description":"Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4081","name":"Enteral ng tubing w/ stylet","description":"Nasogastric tubing with stylet","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0212T","name":"Compre audiometry evaluation","description":"Comprehensive audiometry threshold evaluation and speech recognition (0209t, 0211t combined), automated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8040","name":"Nasal prosthesis","description":"Nasal prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1354.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2100","name":"Bld glucose monitor w voice","description":"Blood glucose monitor with integrated voice synthesizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27880","name":"Amputation of lower leg","description":"Amputation, leg, through tibia and fibula;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83505","name":"Assay total hydroxyproline","description":"Hydroxyproline; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6454","name":"Self-adher band w>=3in <5in/yd","description":"Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90887","name":"Interpj/explnaj rslt psyc xm","description":"Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":52.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76819","name":"Fetal biophys profil w/o nst","description":"Fetal biophysical profile; without non-stress testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6000","name":"Wound warming wound cover","description":"Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.17,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42953","name":"Repair throat esophagus","description":"Pharyngoesophageal repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":743.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96171","name":"Hlth bhv ivntj fam w/o pt ea","description":"Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72080","name":"X-ray exam thoracolmb 2/> vw","description":"Radiologic examination, spine; thoracolumbar junction, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85046","name":"Reticyte/hgb concentrate","description":"Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content [chr], immature reticulocyte fraction [irf], reticulocyte volume [mrv], rna content), direct measurement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70555","name":"Fmri brain by phys/psych","description":"Magnetic resonance imaging, brain, functional mri; requiring physician or psychologist administration of entire neurofunctional testing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28110","name":"Part removal of metatarsal","description":"Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":375.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62351","name":"Implant spinal canal cath","description":"Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":765.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49591","name":"Rpr aa hrn 1st < 3 cm rdc","description":"Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":273.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22114","name":"Remove part lumbar vertebra","description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1011.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77014","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":96.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41512","name":"Tongue suspension","description":"Tongue base suspension, permanent suture technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":510.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34705","name":"Evac rpr a-biiliac ndgft","description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1342.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46255","name":"Remove int/ext hem 1 group","description":"Hemorrhoidectomy, internal and external, single column/group;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":410.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31603","name":"Emer tracheostomy ttrach","description":"Tracheostomy, emergency procedure; transtracheal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":248.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22844","name":"Insert spine fixation device","description":"Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":870.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35180","name":"Rpr cgen av fistula head&nck","description":"Repair, congenital arteriovenous fistula; head and neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33997","name":"Rmvl perq right heart vad","description":"Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70548","name":"Mr angiography neck w/dye","description":"Magnetic resonance angiography, neck; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87501","name":"Influenza dna amp prob 1+","description":"Infectious agent detection by nucleic acid (dna or rna); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92019","name":"Lmtd oph exam general anes","description":"Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; limited","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4371","name":"Skin barrier powder per oz","description":"Ostomy skin barrier, powder, per oz","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10060","name":"I&d abscess simple/single","description":"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6707","name":"Term dev mech hook vol close","description":"Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":680.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92072","name":"Fitg c-lens keratoconus 1st","description":"Fitting of contact lens for management of keratoconus, initial fitting","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.92,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59150","name":"Treat ectopic pregnancy","description":"Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2030","name":"Kafo dbl solid stirrup w/o j","description":"Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar ak orthosis), without knee joint, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9507","name":"In111 capromab","description":"Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43192","name":"Esophagoscp rig trnso inject","description":"Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0810","name":"Halo cervical into jckt vest","description":"Halo procedure, cervical halo incorporated into jacket vest","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0172T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73100","name":"X-ray exam of wrist","description":"Radiologic examination, wrist; 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78594","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":194.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85335","name":"Factor inhibitor test","description":"Factor inhibitor test","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70545","name":"Mr angiography head w/dye","description":"Magnetic resonance angiography, head; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82633","name":"Desoxycorticosterone","description":"Desoxycorticosterone, 11-","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83930","name":"Assay of blood osmolality","description":"Osmolality; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87561","name":"M.avium-intra dna amp prob","description":"Infectious agent detection by nucleic acid (dna or rna); mycobacteria avium-intracellulare, amplified probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26341","name":"Manipulat palm cord post inj","description":"Manipulation, palmar fascial cord (ie, dupuytrens cord), post enzyme injection (eg, collagenase), single cord","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7506","name":"Hmes/trachvalve adhesivedisk","description":"Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0438","name":"Ppps, initial visit","description":"Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":100.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78350","name":"Bone mineral single photon","description":"Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28345","name":"Repair webbed toe(s)","description":"Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33503","name":"Coronary artery graft","description":"Repair of anomalous coronary artery from pulmonary artery origin; by graft, without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1147.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44005","name":"Freeing of bowel adhesion","description":"Enterolysis (freeing of intestinal adhesion) (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":910.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22554","name":"Arthrd ant ntrbd min dsc crv","description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below c2","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1113.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79200","name":"Nuclear rx intracav admin","description":"Radiopharmaceutical therapy, by intracavitary administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29405","name":"Appl short leg cast","description":"Application of short leg cast (below knee to toes);","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33030","name":"Partial removal of heart sac","description":"Pericardiectomy, subtotal or complete; without cardiopulmonary bypass","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88309","name":"Tissue exam by pathologist","description":"Level vi - surgical pathology, gross and microscopic examination bone resection breast, mastectomy - with regional lymph nodes colon, segmental resection for tumor colon, total resection esophagus, partial/total resection extremity, disarticulation fetus, with dissection larynx, partial/total resect","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01620","name":"Anes clsd px shoulder joint","description":"Anesthesia for all closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87188","name":"Sc std macrobroth dil meth","description":"Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70543","name":"Mri orbt/fac/nck w/o &w/dye","description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0018","name":"Detach adjust armrst upper","description":"Detachable, adjustable height armrest, upper portion, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84300","name":"Assay of urine sodium","description":"Sodium; urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29580","name":"Strapping unna boot","description":"Strapping; unna boot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":51.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8300","name":"Truss single w/ standard pad","description":"Truss, single with standard pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3206","name":"Hightop w/ supp/pronator chi","description":"Orthopedic shoe, hightop with supinator or pronator, child","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83491","name":"Asy hydroxycorticosteroids17","description":"Hydroxycorticosteroids, 17- (17-ohcs)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93530","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":968.88,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82565","name":"Assay of creatinine","description":"Creatinine; blood","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61592","name":"Orbitocranial approach/skull","description":"Orbitocranial zygomatic approach to middle cranial fossa (cavernous sinus and carotid artery, clivus, basilar artery or petrous apex) including osteotomy of zygoma, craniotomy, extra- or intradural elevation of temporal lobe","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26434","name":"Repair/graft finger tendon","description":"Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5410","name":"Postop dsg bk ea add cast ch","description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":207.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83950","name":"Oncoprotein her-2/neu","description":"Oncoprotein; her-2/neu","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":35.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"14041","name":"Tis trnfr f/c/c/m/n/a/g/h/f","description":"Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73206","name":"Ct angio upr extrm w/o&w/dye","description":"Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43310","name":"Repair of esophagus","description":"Esophagoplasty (plastic repair or reconstruction), thoracic approach; without repair of tracheoesophageal fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1227.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36583","name":"Replace tunneled cv cath","description":"Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25444","name":"Arthrp w/prostc lunate","description":"Arthroplasty with prosthetic replacement; lunate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":699.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0409","name":"Corf related serv 15 mins ea","description":"Social work and psychological services, directly relating to and/or furthering the patients rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99412","name":"Preventive counseling group","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40820","name":"Treatment of mouth lesion","description":"Destruction of lesion or scar of vestibule of mouth by physical methods (eg, laser, thermal, cryo, chemical)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6637","name":"Nudge control elbow lock","description":"Upper extremity addition, nudge control elbow lock","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82164","name":"Angiotensin i enzyme test","description":"Angiotensin i - converting enzyme (ace)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27360","name":"Partial removal leg bone(s)","description":"Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or bone abscess)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31297","name":"Nsl/sins ndsc surg sphn sins","description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50433","name":"Plmt nephroureteral catheter","description":"Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":924.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41250","name":"Repair tongue laceration","description":"Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97542","name":"Wheelchair mngment training","description":"Wheelchair management (eg, assessment, fitting, training), each 15 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64726","name":"Dcmprn plantar digital nerve","description":"Decompression; plantar digital nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67105","name":"Repair detached retina pc","description":"Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0399","name":"Home sleep test/type 3 porta","description":"Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75885","name":"Vein x-ray liver w/hemodynam","description":"Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15775","name":"Hair trnspl 1-15 punch grfts","description":"Punch graft for hair transplant; 1 to 15 punch grafts","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4223","name":"Infusion supplies w/o pump","description":"Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27323","name":"Biopsy thigh soft tissues","description":"Biopsy, soft tissue of thigh or knee area; superficial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88108","name":"Cytopath concentrate tech","description":"Cytopathology, concentration technique, smears and interpretation (eg, saccomanno technique)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5677","name":"Bk knee joints polycentric p","description":"Additions to lower extremity, below knee, knee joints, polycentric, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":245.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87880","name":"Strep a assay w/optic","description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; streptococcus, group a","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15155","name":"Tis cltr agrft f/s/n/h/f/g 1","description":"Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":513.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71120","name":"X-ray exam breastbone 2/>vws","description":"Radiologic examination; sternum, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0455","name":"Fecal microbiota prep instil","description":"Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":78.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25455","name":"Epiphysl arrst dstl rds&ulna","description":"Epiphyseal arrest by epiphysiodesis or stapling; distal radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74328","name":"X-ray bile duct endoscopy","description":"Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4399","name":"Ostomy irrig cone/cath w brs","description":"Ostomy irrigation supply; cone/catheter, with or without brush","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88342","name":"Imhchem/imcytchm 1st antb","description":"Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55175","name":"Revision of scrotum","description":"Scrotoplasty; simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93740","name":"Temperature gradient studies","description":"Temperature gradient studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29805","name":"Sho arthrs dx +- synovial bx","description":"Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":394.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29862","name":"Hip arthr0 w/debridement","description":"Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70460","name":"Ct head/brain w/dye","description":"Computed tomography, head or brain; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":127.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0047","name":"Elev legrst upr hangr rep ea","description":"Elevating legrest, upper hanger bracket, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97112","name":"Neuromuscular reeducation","description":"Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0163","name":"Commode chair with fixed arm","description":"Commode chair, mobile or stationary, with fixed arms","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98966","name":"Ph1 assmt&mgmt nqhp 5-10","description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management se","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41825","name":"Excision of gum lesion","description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54360","name":"Penis plastic surgery","description":"Plastic operation on penis to correct angulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2231","name":"Solid seat support base","description":"Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76536","name":"Us exam of head and neck","description":"Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":92.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35151","name":"Repair defect of artery","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, popliteal artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95900","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81163","name":"Brca1&2 gene full seq alys","description":"Brca1 (brca1, dna repair associated), brca2 (brca2, dna repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4366","name":"Ostomy vent","description":"Ostomy vent, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4423","name":"Ost pch for bar w lk fl/fltr","description":"Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0509T","name":"Pattern erg w/i&r","description":"Electroretinography (erg) with interpretation and report, pattern (perg)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95887","name":"Musc tst done w/n tst nonext","description":"Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57296","name":"Revise vag graft open abd","description":"Revision (including removal) of prosthetic vaginal graft; open abdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":601.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50693","name":"Plmt ureteral stent prq","description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15860","name":"Iv njx tst vasc flo flap/grf","description":"Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61610","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1716.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72158","name":"Mri lumbar spine w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83987","name":"Exhaled breath condensate","description":"Ph; exhaled breath condensate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97161","name":"Pt eval low complex 20 min","description":"Physical therapy evaluation: low complexity, requiring these components: a history with no personal factors and/or comorbidities that impact the plan of care; an examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35188","name":"Rpr acq av fistula head&neck","description":"Repair, acquired or traumatic arteriovenous fistula; head and neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1169.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78700","name":"Kidney imaging morphol","description":"Kidney imaging morphology;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2625","name":"Enlargemnt of eye prosthesis","description":"Enlargement of ocular prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74420","name":"Urography rtrgr +-kub","description":"Urography, retrograde, with or without kub","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25490","name":"Prophylactic tx radius","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81174","name":"Ar gene known famil variant","description":"Ar (androgen receptor) (eg, spinal and bulbar muscular atrophy, kennedy disease, x chromosome inactivation) gene analysis; known familial variant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50100","name":"Trnsxj/repos abrrnt rnl vsls","description":"Transection or repositioning of aberrant renal vessels (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47490","name":"Incision of gallbladder","description":"Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":253.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5986","name":"Multi-axial rotation unit","description":"All lower extremity prostheses, multi-axial rotation unit (mcp or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78072","name":"Parathyrd planar w/spect&ct","description":"Parathyroid planar imaging (including subtraction, when performed); with tomographic (spect), and concurrently acquired computed tomography (ct) for anatomical localization","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":360.13,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36640","name":"Insertion catheter artery","description":"Arterial catheterization for prolonged infusion therapy (chemotherapy), cutdown","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64874","name":"Repair & revise nerve add-on","description":"Suture of nerve; requiring extensive mobilization, or transposition of nerve (list separately in addition to code for nerve suture)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37617","name":"Ligation major artery abd","description":"Ligation, major artery (eg, post-traumatic, rupture); abdomen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86325","name":"Other immunoelectrophoresis","description":"Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40650","name":"Rpr lip fth vermilion only","description":"Repair lip, full thickness; vermilion only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":364.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95860","name":"Needle emg 1 extremity","description":"Needle electromyography; 1 extremity with or without related paraspinal areas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90870","name":"Electroconvulsive therapy","description":"Electroconvulsive therapy (includes necessary monitoring)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25492","name":"Prophylactic tx radius&ulna","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius and ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96922","name":"Excimer lsr psriasis>500sqcm","description":"Excimer laser treatment for psoriasis; over 500 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28225","name":"Release of foot tendon","description":"Tenolysis, extensor, foot; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45123","name":"Partial proctectomy","description":"Proctectomy, partial, without anastomosis, perineal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":888.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64555","name":"Implant neuroelectrodes","description":"Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22849","name":"Reinsert spinal fixation","description":"Reinsertion of spinal fixation device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1147.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24100","name":"Arthrt elbw synovial bx only","description":"Arthrotomy, elbow; with synovial biopsy only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":351.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70481","name":"Ct orbit/ear/fossa w/dye","description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":176.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15157","name":"Tis clt agrft f/s/n/h/f/g ea","description":"Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83719","name":"Assay of blood lipoprotein","description":"Lipoprotein, direct measurement; vldl cholesterol","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86674","name":"Giardia lamblia antibody","description":"Antibody; giardia lamblia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44111","name":"Excision of bowel lesion(s)","description":"Excision of 1 or more lesions of small or large intestine not requiring anastomosis, exteriorization, or fistulization; multiple enterotomies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":799.12,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0266","name":"Hosp bed total elec w/o matt","description":"Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G9685","name":"Acute nursing facility care","description":"Physician service or other qualified health care professional for the evaluation and management of a beneficiarys acute change in condition in a nursing facility. this service is for a demonstration project","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4376","name":"Drainable rubber pch w fcplt","description":"Ostomy pouch, drainable, with faceplate attached, rubber, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21049","name":"Excis uppr jaw cyst w/repair","description":"Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21180","name":"Rcnstj forehead w/autograft","description":"Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83632","name":"Placental lactogen","description":"Lactogen, human placental (hpl) human chorionic somatomammotropin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36905","name":"Thrmbc/nfs dialysis circuit","description":"Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thromboly","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1202.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27485","name":"Surgery to stop leg growth","description":"Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or valgus)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":566.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"59514","name":"Cesarean delivery only","description":"Cesarean delivery only;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01936","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24930","name":"Amputation follow-up surgery","description":"Amputation, arm through humerus; re-amputation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21335","name":"Open tx nose & septal fx","description":"Open treatment of nasal fracture; with concomitant open treatment of fractured septum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":579.07,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11740","name":"Evacuation subungual hmtma","description":"Evacuation of subungual hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93017","name":"Cv stress test tracing only","description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":33.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77048","name":"Mri breast c-+ w/cad uni","description":"Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (cad real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25491","name":"Prophylactic tx ulna","description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; ulna","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":623.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72125","name":"Ct neck spine w/o dye","description":"Computed tomography, cervical spine; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36440","name":"Bld push tfuj 2 yr/<","description":"Push transfusion, blood, 2 years or younger","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01630","name":"Anes opn/arthr px sho jt nos","description":"Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4312","name":"Cath w/o bag 2-way silicone","description":"Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57130","name":"Excision vaginal septum","description":"Excision of vaginal septum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76881","name":"Us compl joint r-t w/img","description":"Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26990","name":"Drainage of pelvis lesion","description":"Incision and drainage, pelvis or hip joint area; deep abscess or hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19297","name":"Place breast cath for rad","description":"Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27048","name":"Exc hip/pelv tum deep < 5 cm","description":"Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B5100","name":"Parenteral solution hepatic","description":"Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, hepatic, hepatamine-premix","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43202","name":"Esophagoscopy flex biopsy","description":"Esophagoscopy, flexible, transoral; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85055","name":"Reticulated platelet assay","description":"Reticulated platelet assay","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17271","name":"Dstr mal les s/n/h/f/g 0.6-1","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21193","name":"Reconst lwr jaw w/o graft","description":"Reconstruction of mandibular rami, horizontal, vertical, c, or l osteotomy; without bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":993.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27475","name":"Surgery to stop leg growth","description":"Arrest, epiphyseal, any method (eg, epiphysiodesis); distal femur","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43351","name":"Surgical opening esophagus","description":"Esophagostomy, fistulization of esophagus, external; thoracic approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3060","name":"Foot arch supp longitud/meta","description":"Foot, arch support, removable, premolded, longitudinal/ metatarsal, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35540","name":"Art byp grft aortbifemoral","description":"Bypass graft, with vein; aortobifemoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2165.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L4090","name":"Repl met band kafo-afo calf/","description":"Replace metal bands kafo-afo, calf or distal thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24802","name":"Arthrd elbow jt autog graft","description":"Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36466","name":"Njx noncmpnd sclrsnt mlt vn","description":"Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1360.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2037","name":"Kafo plas sing free knee mol","description":"Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1019.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94016","name":"Review patient spirometry","description":"Patient-initiated spirometric recording per 30-day period of time; review and interpretation only by a physician or other qualified health care professional","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78445","name":"Vascular flow imaging","description":"Non-cardiac vascular flow imaging (ie, angiography, venography)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"13122","name":"Cmplx rpr s/a/l addl 5 cm/>","description":"Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42842","name":"Extensive surgery of throat","description":"Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; without closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42104","name":"Excision lesion mouth roof","description":"Excision, lesion of palate, uvula; without closure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83090","name":"Assay of homocysteine","description":"Homocysteine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35623","name":"Bpg axillary-pop/-tibial","description":"Bypass graft, with other than vein; axillary-popliteal or -tibial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1159.5,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37188","name":"Ven mechnl thrmbc repeat tx","description":"Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":813.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77763","name":"Apply intrcav radiat compl","description":"Intracavitary radiation source application; complex","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51880","name":"Repair of bladder opening","description":"Closure of cystostomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":380.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99212","name":"Office o/p est sf 10 min","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 10 minutes must be met o","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81443","name":"Genetic tstg severe inh cond","description":"Genetic testing for severe inherited conditions (eg, cystic fibrosis, ashkenazi jewish-associated disorders [eg, bloom syndrome, canavan disease, fanconi anemia type c, mucolipidosis type vi, gaucher disease, tay-sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6203","name":"Composite drsg <= 16 sq in","description":"Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73501","name":"X-ray exam hip uni 1 view","description":"Radiologic examination, hip, unilateral, with pelvis when performed; 1 view","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0042","name":"Standard size ftplate rep ea","description":"Standard size footplate, replacement only, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29822","name":"Sho arthrs srg lmtd dbrdmt","description":"Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":484.76,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86001","name":"Allergen specific igg","description":"Allergen specific igg quantitative or semiquantitative, each allergen","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6884","name":"Replc sockt above elbow disa","description":"Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1154.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37735","name":"Lig&div&compl strpg saph vn","description":"Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0856","name":"Pwc gp3 std sing pow opt s/b","description":"Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86850","name":"Rbc antibody screen","description":"Antibody screen, rbc, each serum technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34520","name":"Cross-over vein graft","description":"Cross-over vein graft to venous system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":536.67,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72197","name":"Mri pelvis w/o & w/dye","description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28446","name":"Opn osteochondrl agrft talus","description":"Open osteochondral autograft, talus (includes obtaining graft[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1034.94,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4570","name":"Splint","description":"Splint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96922","name":"Excimer lsr psriasis>500sqcm","description":"Excimer laser treatment for psoriasis; over 500 sq cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44144","name":"Partial removal of colon","description":"Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23066","name":"Biopsy shoulder tissues","description":"Biopsy, soft tissue of shoulder area; deep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38212","name":"Rbc depletion of harvest","description":"Transplant preparation of hematopoietic progenitor cells; red blood cell removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61596","name":"Transcochlear approach/skull","description":"Transcochlear approach to posterior cranial fossa, jugular foramen or midline skull base, including labyrinthectomy, decompression, with or without mobilization of facial nerve and/or petrous carotid artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89136","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41155","name":"Tongue jaw & neck surgery","description":"Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection (commando type)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2332.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2208","name":"Cylinder tank carrier","description":"Wheelchair accessory, cylinder tank carrier, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95887","name":"Musc tst done w/n tst nonext","description":"Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":56.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75574","name":"Ct angio hrt w/3d image","description":"Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3d image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":232.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28052","name":"Biopsy of foot joint lining","description":"Arthrotomy with biopsy; metatarsophalangeal joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28086","name":"Excise foot tendon sheath","description":"Synovectomy, tendon sheath, foot; flexor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4346","name":"Cath indw foley 3 way","description":"Indwelling catheter; foley type, three way for continuous irrigation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23440","name":"Remove/transplant tendon","description":"Resection or transplantation of long tendon of biceps","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":637.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61605","name":"Resect/excise cranial lesion","description":"Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; extradural","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1783.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82652","name":"Vit d 1 25-dihydroxy","description":"Vitamin d; 1, 25 dihydroxy, includes fraction(s), if performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75756","name":"Artery x-rays chest","description":"Angiography, internal mammary, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76942","name":"Echo guide for biopsy","description":"Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":44.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84449","name":"Assay of transcortin","description":"Transcortin (cortisol binding globulin)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35092","name":"Repair artery rupture aorta","description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2299.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95819","name":"Eeg awake and asleep","description":"Electroencephalogram (eeg); including recording awake and asleep","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":293.46,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"42330","name":"Removal of salivary stone","description":"Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00830","name":"Anes hernia rpr lwr abd nos","description":"Anesthesia for hernia repairs in lower abdomen; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21060","name":"Remove jaw joint cartilage","description":"Meniscectomy, partial or complete, temporomandibular joint (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4216","name":"Parenteral nutrition additiv","description":"Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90913","name":"Bfb training ea addl 15 min","description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including emg and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4932","name":"Reusable rectal thermometer","description":"Rectal thermometer, reusable, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.74,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74430","name":"Contrast x-ray bladder","description":"Cystography, minimum of 3 views, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0419T","name":"Dstrj neurofibroma xtnsv","description":"Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); face, head and neck, greater than 50 neurofibromas","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71120","name":"X-ray exam breastbone 2/>vws","description":"Radiologic examination; sternum, minimum of 2 views","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86618","name":"Lyme disease antibody","description":"Antibody; borrelia burgdorferi (lyme disease)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","QW","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36481","name":"Insertion of catheter vein","description":"Percutaneous portal vein catheterization by any method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1548.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0994","name":"Wheelchair arm rest","description":"Arm rest, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28280","name":"Fusion of toes","description":"Syndactylization, toes (eg, webbing or kelikian type procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5640","name":"Knee disarticulat leather so","description":"Addition to lower extremity, knee disarticulation, leather socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":423.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36253","name":"Ins cath ren art 2nd+ unilat","description":"Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, an","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2010","name":"Remot image submit by pt","description":"Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m ser","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8046","name":"Partial facial prosthesis","description":"Partial facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1467.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17280","name":"Dstr mal ls f/e/e/n/l/m .5/<","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74241","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99173","name":"Visual acuity screen","description":"Screening test of visual acuity, quantitative, bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24345","name":"Repr elbw med ligmnt w/tissu","description":"Repair medial collateral ligament, elbow, with local tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6965","name":"Shldr disartic myoelectronic","description":"Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7031.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82088","name":"Assay of aldosterone","description":"Aldosterone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29873","name":"Arthrs knee surg w/lat rls","description":"Arthroscopy, knee, surgical; with lateral release","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A7043","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76982","name":"Use 1st target lesion","description":"Ultrasound, elastography; first target lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1700","name":"Leg perthes orth toronto typ","description":"Legg perthes orthosis, (toronto type), custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92602","name":"Reprogram cochlear implt <7","description":"Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97162","name":"Pt eval mod complex 30 min","description":"Physical therapy evaluation: moderate complexity, requiring these components: a history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; an examination of body systems using standardized tests and measures in addressing a total of 3 or more elements fro","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92993","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":561.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21556","name":"Exc neck tum deep < 5 cm","description":"Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":443.23,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92609","name":"Use of speech device service","description":"Therapeutic services for the use of speech-generating device, including programming and modification","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0117","name":"Underarm springassist crutch","description":"Crutch, underarm, articulating, spring assisted, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83864","name":"Mucopolysaccharides","description":"Mucopolysaccharides, acid, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49500","name":"Rpr ing hernia init reduce","description":"Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26720","name":"Treat finger fracture each","description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46937","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":182.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64890","name":"Nrv grf 1strnd hnd/foot <4cm","description":"Nerve graft (includes obtaining graft), single strand, hand or foot; up to 4 cm length","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61564","name":"Excision of skull tumor","description":"Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); with optic nerve decompression","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2208.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01860","name":"Anes forearm wrist/hand cast","description":"Anesthesia for forearm, wrist, or hand cast application, removal, or repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3650","name":"So 8 abd restraint pre ots","description":"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7400","name":"Add ue prost be/wd, ultlite","description":"Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94200","name":"Lung function test (mbc/mvv)","description":"Maximum breathing capacity, maximal voluntary ventilation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6810","name":"Term dev precision pinch dev","description":"Addition to terminal device, precision pinch device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6212","name":"Foam drg <=16 sq in w/border","description":"Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2211","name":"Lens sphcy bifo 7.25-12/.25-","description":"Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35341","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; mesenteric, celiac, or renal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1211.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94005","name":"Home vent mgmt supervision","description":"Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 3","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35700","name":"Reoperation bypass graft","description":"Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":134.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82543","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32507","name":"Wedge resect of lung diag","description":"Thoracotomy; with diagnostic wedge resection followed by anatomic lung resection (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82785","name":"Assay of ige","description":"Gammaglobulin (immunoglobulin); ige","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85245","name":"Clot factor viii vw ristoctn","description":"Clotting; factor viii, vw factor, ristocetin cofactor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01214","name":"Anes open px tot hip arthrp","description":"Anesthesia for open procedures involving hip joint; total hip arthroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86684","name":"Hemophilus influenza antibdy","description":"Antibody; haemophilus influenza","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56606","name":"Biopsy of vulva/perineum","description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":24.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30200","name":"Injection treatment of nose","description":"Injection into turbinate(s), therapeutic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":83.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75726","name":"Artery x-rays abdomen","description":"Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64402","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":124.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78195","name":"Lymph system imaging","description":"Lymphatics and lymph nodes imaging","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72142","name":"Mri neck spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35304","name":"Rechanneling of artery","description":"Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2328","name":"Head/extremity control inter","description":"Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87510","name":"Gardner vag dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); gardnerella vaginalis, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50434","name":"Convert nephrostomy catheter","description":"Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, via pre-existing nephrostomy tract","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":736.28,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7405","name":"Add ue prost s/d acrylic","description":"Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":354.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45308","name":"Proctosigmoidoscopy removal","description":"Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":146.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"34101","name":"Removal of artery clot","description":"Embolectomy or thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36218","name":"Place catheter in artery","description":"Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":187.34,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70030","name":"X-ray eye for foreign body","description":"Radiologic examination, eye, for detection of foreign body","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97165","name":"Ot eval low complex 30 min","description":"Occupational therapy evaluation, low complexity, requiring these components: an occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; an assessment(s) that identifies 1-3 performance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50200","name":"Renal biopsy perq","description":"Renal biopsy; percutaneous, by trocar or needle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90837","name":"Psytx w pt 60 minutes","description":"Psychotherapy, 60 minutes with patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":103.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54000","name":"Slitting of prepuce","description":"Slitting of prepuce, dorsal or lateral (separate procedure); newborn","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84585","name":"Assay of urine vma","description":"Vanillylmandelic acid (vma), urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1006","name":"Pwr seat combo w/o shear","description":"Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1290","name":"Lateral trochanteric pad","description":"Addition to tlso, (low profile), lateral trochanteric pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47900","name":"Suture bile duct injury","description":"Suture of extrahepatic biliary duct for pre-existing injury (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21340","name":"Perq tx nasoethmoid fx","description":"Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including repair of canthal ligaments and/or the nasolacrimal apparatus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":606.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32820","name":"Reconstruct injured chest","description":"Major reconstruction, chest wall (posttraumatic)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86140","name":"C-reactive protein","description":"C-reactive protein;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6222","name":"Gauze <=16 in no w/sal w/o b","description":"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80307","name":"Drug test prsmv chem anlyzr","description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, eia, elisa, emit, fpia, ia, kims, ria]), chromatography (eg, gc, hplc), and mass spectrometry either with or without chromatography, (eg, dart","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31235","name":"Nsl/sins ndsc dx sphn sinusc","description":"Nasal/sinus endoscopy, diagnostic; with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":221.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2601","name":"Gen w/c cushion wdth < 22 in","description":"General use wheelchair seat cushion, width less than 22 inches, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"41008","name":"Drainage of mouth lesion","description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submandibular space","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":294.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0439","name":"Stationary liquid 02","description":"Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27762","name":"Cltx med ankle fx w/mnpj","description":"Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44137","name":"Remove intestinal allograft","description":"Removal of transplanted intestinal allograft, complete","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87520","name":"Hepatitis c rna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); hepatitis c, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83634","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0190T","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":165.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86155","name":"Chemotaxis assay","description":"Chemotaxis assay, specify method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99255","name":"Ip/obs consltj new/est hi 80","description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. when using total time on the date of the encounter for code selection, 80 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":167.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01772","name":"Anes art upr arm&elbw emblc","description":"Anesthesia for procedures on arteries of upper arm and elbow; embolectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0328","name":"Fecal blood scrn immunoassay","description":"Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","QW","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90840","name":"Psytx crisis ea addl 30 min","description":"Psychotherapy for crisis; each additional 30 minutes (list separately in addition to code for primary service)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":39.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77331","name":"Special radiation dosimetry","description":"Special dosimetry (eg, tld, microdosimetry) (specify), only when prescribed by the treating physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00790","name":"Anes iper upr abd nos","description":"Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31572","name":"Largsc w/laser dstrj les","description":"Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8417","name":"Pros sheath/sock w gel cushn","description":"Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5697","name":"Ak/knee disartic pelvic band","description":"Addition to lower extremity, above knee or knee disarticulation, pelvic band","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":40.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82239","name":"Bile acids total","description":"Bile acids; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95937","name":"Neuromuscular junction test","description":"Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":62.87,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67412","name":"Explore/treat eye socket","description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29540","name":"Strapping ankle &/foot","description":"Strapping; ankle and/or foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31830","name":"Revise windpipe scar","description":"Revision of tracheostomy scar","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77067","name":"Scr mammo bi incl cad","description":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95833","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":27.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4465","name":"Non-elastic extremity binder","description":"Non-elastic binder for extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"A6202","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76145","name":"Med physic dos eval rad exps","description":"Medical physics dose evaluation for radiation exposure that exceeds institutional review threshold, including report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":692.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75560","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":720.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74455","name":"X-ray urethra/bladder","description":"Urethrocystography, voiding, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95816","name":"Eeg awake and drowsy","description":"Electroencephalogram (eeg); including recording awake and drowsy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":246.48,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87912","name":"Nfct agt gntyp alys hep b","description":"Infectious agent genotype analysis by nucleic acid (dna or rna); hepatitis b virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0618","name":"Apnea monitor","description":"Apnea monitor, without recording feature","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64790","name":"Removal of nerve lesion","description":"Excision of neurofibroma or neurolemmoma; major peripheral nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"72149","name":"Mri lumbar spine w/dye","description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85300","name":"Antithrombin iii activity","description":"Clotting inhibitors or anticoagulants; antithrombin iii, activity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49651","name":"Lap ing hernia repair recur","description":"Laparoscopy, surgical; repair recurrent inguinal hernia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11970","name":"Rplcmt tiss xpndr perm implt","description":"Replacement of tissue expander with permanent implant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0490","name":"Tlso rigid plastic pre one","description":"Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, res","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":138.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63050","name":"Cervical laminoplsty 2/> seg","description":"Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1334.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31590","name":"Reinnervate larynx","description":"Laryngeal reinnervation by neuromuscular pedicle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":655.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0372","name":"Md service required for pmd","description":"Physician service required to establish and document the need for a power mobility device","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2211","name":"Pneumatic propulsion tire","description":"Manual wheelchair accessory, pneumatic propulsion tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95813","name":"Eeg extnd mntr 61-119 min","description":"Electroencephalogram (eeg) extended monitoring; 61-119 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76813","name":"Ob us nuchal meas 1 gest","description":"Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":94.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27416","name":"Osteochondral knee autograft","description":"Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":830.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83060","name":"Hgb sulfhemoglobin quan","description":"Hemoglobin; sulfhemoglobin, quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25600","name":"Cltx dst rdl fx/ephys sep wo","description":"Closed treatment of distal radial fracture (eg, colles or smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27041","name":"Biopsy of soft tissues","description":"Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":586.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2214","name":"Pneumatic caster tire each","description":"Manual wheelchair accessory, pneumatic caster tire, any size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4521","name":"Adult size brief/diaper sm","description":"Adult sized disposable incontinence product, brief/diaper, small, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99497","name":"Advncd care plan 30 min","description":"Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surroga","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":70.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93228","name":"Remote 30 day ecg rev/report","description":"External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ecg data storage (retrievable with query) with ecg triggered and patient selected events transmitted to a remote attended surveillance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8020","name":"Mastectomy form","description":"Breast prosthesis, mastectomy form","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26525","name":"Release finger contracture","description":"Capsulectomy or capsulotomy; interphalangeal joint, each joint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":546.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92134","name":"Cptrz oph dx img pst sgm rta","description":"Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [oct]), posterior segment, with interpretation and report, unilateral or bilateral; retina","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90967","name":"Esrd svc pr day pt <2","description":"End-stage renal disease (esrd) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.64,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69710","name":"Implant/replace hearing aid","description":"Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6010","name":"Part hand little/ring","description":"Partial hand, little and/or ring finger remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":770.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00164","name":"Anes px nose&sins bx sft tis","description":"Anesthesia for procedures on nose and accessory sinuses; biopsy, soft tissue","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78265","name":"Gstr emptg img sm bwl trnst","description":"Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21295","name":"Revision of jaw muscle/bone","description":"Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); extraoral approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":153.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92227","name":"Img rta detcj/mntr ds staff","description":"Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87276","name":"Influenza a ag if","description":"Infectious agent antigen detection by immunofluorescent technique; influenza a virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0930","name":"Fracture frame free standing","description":"Fracture frame, free standing, includes weights","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55041","name":"Removal of hydroceles","description":"Excision of hydrocele; bilateral","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99489","name":"Cplx chrnc care ea addl 30","description":"Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":36.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97545","name":"Work hardening","description":"Work hardening/conditioning; initial 2 hours","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93453","name":"R&l hrt cath w/ventriclgrphy","description":"Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00216","name":"Anes icr px vascular px","description":"Anesthesia for intracranial procedures; vascular procedures","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28715","name":"Arthrodesis triple","description":"Arthrodesis; triple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75558","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":551.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45172","name":"Exc rect tum transanal full","description":"Excision of rectal tumor, transanal approach; including muscularis propria (ie, full thickness)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":647.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73718","name":"Mri lower extremity w/o dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17276","name":"Dstr mal les s/n/h/f/g >4.0","description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76817","name":"Transvaginal us obstetric","description":"Ultrasound, pregnant uterus, real time with image documentation, transvaginal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71260","name":"Ct thorax dx c+","description":"Computed tomography, thorax, diagnostic; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81121","name":"Idh2 common variants","description":"Idh2 (isocitrate dehydrogenase 2 [nadp+], mitochondrial) (eg, glioma), common variants (eg, r140w, r172m)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":147.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88141","name":"Cytopath c/v interpret","description":"Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27792","name":"Treatment of ankle fracture","description":"Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":541.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30110","name":"Removal of nose polyp(s)","description":"Excision, nasal polyp(s), simple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":179.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21080","name":"Impres&prep def obt prosth","description":"Impression and custom preparation; definitive obturator prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"39220","name":"Resect mediastinal tumor","description":"Resection of mediastinal tumor","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":977.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4246","name":"Betadine/phisohex solution","description":"Betadine or phisohex solution, per pint","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73720","name":"Mri lwr extremity w/o&w/dye","description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":307.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"75801","name":"Lymph vessel x-ray arm/leg","description":"Lymphangiography, extremity only, unilateral, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"89322","name":"Semen anal strict criteria","description":"Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, kruger)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55831","name":"Removal of prostate","description":"Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); retropubic, subtotal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82240","name":"Bile acids cholylglycine","description":"Bile acids; cholylglycine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27601","name":"Decompression of lower leg","description":"Decompression fasciotomy, leg; posterior compartment(s) only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":375.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26499","name":"Correction claw finger other","description":"Correction claw finger, other methods","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94610","name":"Intrapulm surfactant admn","description":"Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27607","name":"Treat lower leg bone lesion","description":"Incision (eg, osteomyelitis or bone abscess), leg or ankle","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":504.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77432","name":"Stereotactic radiation trmt","description":"Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23655","name":"Cltx sho dslc w/mnpj w/anes","description":"Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67930","name":"Repair eyelid wound","description":"Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76511","name":"Oph us dx quan a-scan only","description":"Ophthalmic ultrasound, diagnostic; quantitative a-scan only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15937","name":"Exc sac pr ulc prep mus ostc","description":"Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66940","name":"Extraction of lens","description":"Removal of lens material; extracapsular (other than 66840, 66850, 66852)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":470.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95977","name":"Alys cplx cn npgt prgrmg","description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop pa","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62192","name":"Establish brain cavity shunt","description":"Creation of shunt; subarachnoid/subdural-peritoneal, -pleural, other terminus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4540","name":"Reusable underpad chair size","description":"Incontinence product, protective underpad, reusable, chair size, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26170","name":"Removal of palm tendon each","description":"Excision of tendon, palm, flexor or extensor, single, each tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95720","name":"Eeg phy/qhp ea incr w/veeg","description":"Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of eeg recording, interpretation and report after each 24-hour period; w","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28072","name":"Removal of foot joint lining","description":"Synovectomy; metatarsophalangeal joint, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36908","name":"Stent plmt ctr dialysis seg","description":"Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (list separately in addition to","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78206","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":274.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76506","name":"Echo exam of head","description":"Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnormalities), including a-mode encephalography as secondary component where indicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55550","name":"Laparo ligate spermatic vein","description":"Laparoscopy, surgical, with ligation of spermatic veins for varicocele","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47381","name":"Open ablate liver tumor cryo","description":"Ablation, open, of 1 or more liver tumor(s); cryosurgical","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1242.78,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L2108","name":"Afo tib fx cast molded to pt","description":"Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":604.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55680","name":"Remove sperm pouch lesion","description":"Excision of mullerian duct cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24346","name":"Reconstruct elbow med ligmnt","description":"Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":929.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64761","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":358.3,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51710","name":"Change of bladder tube","description":"Change of cystostomy tube; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":106.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1391","name":"Oxygen concentrator, dual","description":"Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21510","name":"Inc deep opng b1 crtx thorax","description":"Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), thorax","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92603","name":"Cochlear implt f/up exam 7/>","description":"Diagnostic analysis of cochlear implant, age 7 years or older; with programming","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"Q0495","name":"Charger elec/combo vad, rep","description":"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5642","name":"Above knee leather socket","description":"Addition to lower extremity, above knee, leather socket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4637","name":"Repl tip cane/crutch/walker","description":"Replacement, tip, cane, crutch, walker, each.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35506","name":"Art byp grft subclav-carotid","description":"Bypass graft, with vein; carotid-subclavian or subclavian-carotid","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1125.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0439","name":"Ppps, subseq visit","description":"Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":68.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61323","name":"Crnec/crnot dcmprv w/lobec","description":"Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; with lobectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2202.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84430","name":"Assay of thiocyanate","description":"Thiocyanate","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95783","name":"Polysom <6 yrs cpap/bilvl","description":"Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4334","name":"Urinary cath leg strap","description":"Urinary catheter anchoring device, leg strap, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10007","name":"Fna bx w/fluor gdn 1st les","description":"Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":237.97,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2615","name":"Pos back post/lat wdth <22in","description":"Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64449","name":"Njx aa&/strd lmbr plex nfs","description":"Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83883","name":"Assay nephelometry not spec","description":"Nephelometry, each analyte not elsewhere specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"68020","name":"Incise/drain eyelid lining","description":"Incision of conjunctiva, drainage of cyst","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25608","name":"Optx dst rd xart fx/epi sep2","description":"Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":692.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5666","name":"Below knee cuff suspension","description":"Addition to lower extremity, below knee, cuff suspension","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6890","name":"Prefab glove for term device","description":"Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82955","name":"Assay of g6pd enzyme","description":"Glucose-6-phosphate dehydrogenase (g6pd); quantitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69440","name":"Exploration of middle ear","description":"Middle ear exploration through postauricular or ear canal incision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43757","name":"Dx duod intub w/asp specs","description":"Duodenal intubation and aspiration, diagnostic, includes image guidance; collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube, includes drug administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":263.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28108","name":"Removal of toe lesions","description":"Excision or curettage of bone cyst or benign tumor, phalanges of foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7016","name":"Nebulizer dome & mouthpiece","description":"Dome and mouthpiece, used with small volume ultrasonic nebulizer","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22800","name":"Arthrd pst dfrm<6 vrt sgm","description":"Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27238","name":"Treat thigh fracture","description":"Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24136","name":"Sequestrectomy radial h/n","description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01400","name":"Anes opn/arthrs knee jt nos","description":"Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36253","name":"Ins cath ren art 2nd+ unilat","description":"Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, an","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1786.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82540","name":"Assay of creatine","description":"Creatine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24615","name":"Optx aqt/chrnc elbow dislc","description":"Open treatment of acute or chronic elbow dislocation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":600.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57022","name":"I&d vaginal hematoma ob/pp","description":"Incision and drainage of vaginal hematoma; obstetrical/postpartum","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L6020","name":"Part hand no fingers","description":"Partial hand, no finger remaining","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":684.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27722","name":"Repair/graft of tibia","description":"Repair of nonunion or malunion, tibia; with sliding graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":754.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4652","name":"Microcapillary tube sealant","description":"Microcapillary tube sealant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35491","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":422.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33859","name":"As-aort grf f/ds oth/thn dsj","description":"Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44700","name":"Suspend bowel w/prosthesis","description":"Exclusion of small intestine from pelvis by mesh or other prosthesis, or native tissue (eg, bladder or omentum)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":801.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50750","name":"Fusion of ureter & kidney","description":"Ureterocalycostomy, anastomosis of ureter to renal calyx","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":933.02,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27580","name":"Fusion of knee","description":"Arthrodesis, knee, any technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00126","name":"Anes px ear tympanotomy","description":"Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84392","name":"Assay of urine sulfate","description":"Sulfate, urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43825","name":"Gastrojejunostomy w/vagotomy","description":"Gastrojejunostomy; with vagotomy, any type","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1099.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80156","name":"Assay carbamazepine total","description":"Carbamazepine; total","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5120","name":"Skin barrier, wipe or swab","description":"Skin barrier, wipes or swabs, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5000","name":"Sho insert w arch toe filler","description":"Partial foot, shoe insert with longitudinal arch, toe filler","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0522T","name":"Prgrmg dev eval wcs ip","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, wireless cardiac stimulator for left ventricular pacing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21147","name":"Rcnstj mdfc lefort i 3/>grf","description":"Reconstruction midface, lefort i; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1371.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27808","name":"Treatment of ankle fracture","description":"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":276.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84244","name":"Assay of renin","description":"Renin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"67880","name":"Revision of eyelid","description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":280.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20501","name":"Njx sinus tract diagnostic","description":"Injection of sinus tract; diagnostic (sinogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2368","name":"Pwr wc drivewheel motor repl","description":"Power wheelchair component, drive wheel motor, replacement only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97039","name":"Unlisted modality","description":"Unlisted modality (specify type and time if constant attendance)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GP","GO",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32668","name":"Thoracoscopy w/w resect diag","description":"Thoracoscopy, surgical; with diagnostic wedge resection followed by anatomic lung resection (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":125.35,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28225","name":"Release of foot tendon","description":"Tenolysis, extensor, foot; single tendon","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":339.45,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33367","name":"Replace aortic valve w/byp","description":"Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37620","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":670.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88152","name":"Cytopath c/v auto redo","description":"Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15600","name":"Delay flap trunk","description":"Delay of flap or sectioning of flap (division and inset); at trunk","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78016","name":"Thyroid met imaging/studies","description":"Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49900","name":"Repair of abdominal wall","description":"Suture, secondary, of abdominal wall for evisceration or dehiscence","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82486","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"53665","name":"Dilation of urethra","description":"Dilation of female urethra, general or conduction (spinal) anesthesia","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99448","name":"Ntrprof ph1/ntrnet/ehr 21-30","description":"Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a verbal and written report to the patients treating/requesting physician or other qualified health care profess","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.47,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T4535","name":"Disposable liner/shield/pad","description":"Disposable liner/shield/guard/pad/undergarment, for incontinence, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77075","name":"Radex osseous survey compl","description":"Radiologic examination, osseous survey; complete (axial and appendicular skeleton)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.26,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0480","name":"Drug test def 1-7 classes","description":"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding i","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":57.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93622","name":"Comp ep eval l ventr pac&rec","description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1987.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"12046","name":"Intmd rpr n-hf/genit20.1-30","description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"55400","name":"Repair of sperm duct","description":"Vasovasostomy, vasovasorrhaphy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22632","name":"Arthrd pst tq 1ntrspc lm ea","description":"Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46945","name":"Int hrhc lig 1 hroid w/o img","description":"Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":264.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2625","name":"Adj skin pro/pos wc cus>=22","description":"Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","KE","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"37201","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":287.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83876","name":"Assay myeloperoxidase","description":"Myeloperoxidase (mpo)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":25.43,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4232","name":"Syringe w/needle insulin 3cc","description":"Syringe with needle for external insulin pump, sterile, 3 cc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19286","name":"Perq dev breast add us imag","description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":242.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71275","name":"Ct angiography chest","description":"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":213.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"0174T","name":"Cad cxr with interp","description":"Computer-aided detection (cad) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation (list s","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11422","name":"Exc h-f-nk-sp b9+marg 1.1-2","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":111.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"48547","name":"Duodenal exclusion","description":"Duodenal exclusion with gastrojejunostomy for pancreatic injury","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1506.98,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94772","name":"Circadian respir pattern rec","description":"Circadian respiratory pattern recording (pediatric pneumogram), 12-24 hour continuous recording, infant","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":178.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11920","name":"Correct skin color 6.0 cm/<","description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"52005","name":"Cysto w/urtrl cathj","description":"Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"26551","name":"Great toe-hand transfer","description":"Transfer, toe-to-hand with microvascular anastomosis; great toe wrap-around with bone graft","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2790.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4150","name":"Ef complet w/intact nutrient","description":"Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78815","name":"Pet image w/ct skull-thigh","description":"Positron emission tomography (pet) with concurrently acquired computed tomography (ct) for attenuation correction and anatomical localization imaging; skull base to mid-thigh","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7033","name":"Replacement nasal pillows","description":"Pillow for use on nasal cannula type interface, replacement only, pair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":14.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0782","name":"Non-programble infusion pump","description":"Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR","KF",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21082","name":"Impres&prep paltl aug prosth","description":"Impression and custom preparation; palatal augmentation prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83907","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10121","name":"Inc&rmvl fb subq tiss comp","description":"Incision and removal of foreign body, subcutaneous tissues; complicated","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0240","name":"Bath/shower chair","description":"Bath/shower chair, with or without wheels, any size","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"66174","name":"Trluml dil aq o/f can w/o st","description":"Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or stent","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":908.44,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88356","name":"Analysis nerve","description":"Morphometric analysis; nerve","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36903","name":"Intro cath dialysis circuit","description":"Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous out","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31825","name":"Repair of windpipe defect","description":"Surgical closure tracheostomy or fistula; with plastic repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83993","name":"Assay for calprotectin fecal","description":"Calprotectin, fecal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63185","name":"Incise spine nrv half segmnt","description":"Laminectomy with rhizotomy; 1 or 2 segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1005.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"V2510","name":"Cntct gas permeable sphericl","description":"Contact lens, gas permeable, spherical, per lens","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43880","name":"Closure gastrocolic fistula","description":"Closure of gastrocolic fistula","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1326.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95715","name":"Veeg ea 12-26hr intmt mntr","description":"Electroencephalogram with video (veeg), review of data, technical description by eeg technologist, each increment of 12-26 hours; with intermittent monitoring and maintenance","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83775","name":"Assay malate dehydrogenase","description":"Malate dehydrogenase","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":4.1,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90832","name":"Psytx w pt 30 minutes","description":"Psychotherapy, 30 minutes with patient","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L5280","name":"Hemipelvect canad sing axis","description":"Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2526.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32900","name":"Removal of rib(s)","description":"Resection of ribs, extrapleural, all stages","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93283","name":"Prgrmg eval implantable dfb","description":"Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantab","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61000","name":"Remove cranial cavity fluid","description":"Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90839","name":"Psytx crisis initial 60 min","description":"Psychotherapy for crisis; first 60 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":82.4,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"32036","name":"Thoracostomy w/flap drainage","description":"Thoracostomy; with open flap drainage for empyema","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":619.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45402","name":"Lap proctopexy w/sig resect","description":"Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1213.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"40720","name":"Repair cleft lip/nasal","description":"Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27372","name":"Removal of foreign body","description":"Removal of foreign body, deep, thigh region or knee area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":499.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27881","name":"Amputation of lower leg","description":"Amputation, leg, through tibia and fibula; with immediate fitting technique including application of first cast","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"19086","name":"Bx breast add lesion mr imag","description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78201","name":"Liver imaging static only","description":"Liver imaging; static only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11740","name":"Evacuation subungual hmtma","description":"Evacuation of subungual hematoma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.82,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35523","name":"Art byp grft brchl-ulnr-rdl","description":"Bypass graft, with vein; brachial-ulnar or -radial","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1126.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"64612","name":"Destroy nerve face muscle","description":"Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1235","name":"Rigid ped wc adjustable","description":"Wheelchair, pediatric size, rigid, adjustable, with seating system","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"58400","name":"Suspension of uterus","description":"Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":288.68,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61510","name":"Crnec treph exc brn tum sttl","description":"Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2004.72,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76120","name":"Cine/video x-rays","description":"Cineradiography/videoradiography, except where specifically included","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45190","name":"Destruction rectal tumor","description":"Destruction of rectal tumor (eg, electrodesiccation, electrosurgery, laser ablation, laser resection, cryosurgery) transanal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78597","name":"Lung perfusion differential","description":"Quantitative differential pulmonary perfusion, including imaging when performed","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":161.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"61888","name":"Revise/remove neuroreceiver","description":"Revision or removal of cranial neurostimulator pulse generator or receiver","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2025","name":"Dis site tele svcs rhc/fqhc","description":"Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":43.39,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95912","name":"Nrv cndj test 11-12 studies","description":"Nerve conduction studies; 11-12 studies","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E2362","name":"Gr24 nonsealed leadacid","description":"Power wheelchair accessory, group 24 non-sealed lead acid battery, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0457","name":"Chest shell","description":"Chest shell (cuirass)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33370","name":"Tcat plmt&rmvl cepd perq","description":"Transcatheter placement and subsequent removal of cerebral embolic protection device(s), including arterial access, catheterization, imaging, and radiological supervision and interpretation, percutaneous (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":109.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44020","name":"Explore small intestine","description":"Enterotomy, small intestine, other than duodenum; for exploration, biopsy(s), or foreign body removal","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93976","name":"Vascular study","description":"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":73.57,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36909","name":"Dialysis circuit embolj","description":"Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50705","name":"Ureteral embolization/occl","description":"Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84620","name":"Xylose tolerance test","description":"Xylose absorption test, blood and/or urine","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.58,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33464","name":"Valvuloplasty tricuspid","description":"Valvuloplasty, tricuspid valve; with ring insertion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2119.56,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A5126","name":"Disk/foam pad +or- adhesive","description":"Adhesive or non-adhesive; disk or foam pad","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99480","name":"Sbsq ic inf pbw 2,501-5,000","description":"Subsequent intensive care, per day, for the evaluation and management of the recovering infant (present body weight of 2,501-5,000 grams)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88358","name":"Analysis tumor","description":"Morphometric analysis; tumor (eg, dna ploidy)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":80.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L7170","name":"Electronic elbow hosmer swit","description":"Electronic elbow, hosmer or equal, switch controlled","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69554","name":"Exc aurl glomus tum extended","description":"Excision aural glomus tumor; extended (extratemporal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":2034.8,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99411","name":"Preventive counseling group","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L8043","name":"Upper facial prosthesis","description":"Upper facial prosthesis, provided by a non-physician","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","KM","95","93","KN"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4606","name":"Oxygen probe used w oximeter","description":"Oxygen probe for use with oximeter device, replacement","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"23155","name":"Removal of humerus lesion","description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93970","name":"Extremity study","description":"Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"73700","name":"Ct lower extremity w/o dye","description":"Computed tomography, lower extremity; without contrast material","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"79440","name":"Nuclear rx intra-articular","description":"Radiopharmaceutical therapy, by intra-articular administration","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1690","name":"Combination bilateral ho","description":"Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78740","name":"Ureteral reflux study","description":"Ureteral reflux study (radiopharmaceutical voiding cystogram)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"95810","name":"Polysom 6/> yrs 4/> param","description":"Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":411.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"22513","name":"Perq vertebral augmentation","description":"Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86403","name":"Particle agglut antbdy scrn","description":"Particle agglutination; screen, each antibody","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33418","name":"Repair tcat mitral valve","description":"Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1556.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82668","name":"Assay of erythropoietin","description":"Erythropoietin","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92523","name":"Speech sound lang comprehen","description":"Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":50.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["99"],"billing_code_modifier":["GN",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"29720","name":"Repair spica body cst/jacket","description":"Repair of spica, body cast or jacket","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"01272","name":"Anes px art femoral art lig","description":"Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery ligation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74430","name":"Contrast x-ray bladder","description":"Cystography, minimum of 3 views, radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","26","95","93","NU","","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93623","name":"Prgrmd stimj&pacg iv rx nfs","description":"Programmed stimulation and pacing after intravenous drug infusion (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99242","name":"Off/op consltj new/est sf 20","description":"Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. when using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0168","name":"Heavyduty/wide commode chair","description":"Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90865","name":"Narcosynthesis","description":"Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital (amytal) interview)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"62100","name":"Repair brain fluid leakage","description":"Craniotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1413.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"33202","name":"Insert epicard eltrd open","description":"Insertion of epicardial electrode(s); open incision (eg, thoracotomy, median sternotomy, subxiphoid approach)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"35236","name":"Repair blvsl vn grf uxtr","description":"Repair blood vessel with vein graft; upper extremity","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46604","name":"Anoscopy and dilation","description":"Anoscopy; with dilation (eg, balloon, guide wire, bougie)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":515.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"25800","name":"Arthrd wrist complete wo grf","description":"Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":612.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56634","name":"Vlvctmy rad comp uni lymphad","description":"Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46614","name":"Anoscopy control bleeding","description":"Anoscopy; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"11400","name":"Exc tr-ext b9+marg 0.5 cm<","description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":77.85,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86789","name":"West nile virus antibody","description":"Antibody; west nile virus","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83045","name":"Hgb methemoglobin qual","description":"Hemoglobin; methemoglobin, qualitative","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"P9604","name":"One-way allow prorated trip","description":"Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93318","name":"Echo transesophageal intraop","description":"Echocardiography, transesophageal (tee) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basi","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":188.06,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43107","name":"Removal of esophagus","description":"Total or near total esophagectomy, without thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (transhiatal)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51880","name":"Repair of bladder opening","description":"Closure of cystostomy (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27870","name":"Fusion of ankle joint open","description":"Arthrodesis, ankle, open","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":854.79,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A6253","name":"Absorpt drg > 48 sq in w/o b","description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78808","name":"Iv inj ra drug dx study","description":"Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid adenoma)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.32,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92618","name":"Ex for nonspeech dev rx add","description":"Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21151","name":"Rcnstj mdfc lefrtii w/b1 grf","description":"Reconstruction midface, lefort ii; any direction, requiring bone grafts (includes obtaining autografts)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"B4100","name":"Food thickener oral","description":"Food thickener, administered orally, per ounce","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":0.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"45331","name":"Sigmoidoscopy and biopsy","description":"Sigmoidoscopy, flexible; with biopsy, single or multiple","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"57555","name":"Remove cervix/repair vagina","description":"Excision of cervical stump, vaginal approach; with anterior and/or posterior repair","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":392.66,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94250","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96118","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":66.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93660","name":"Tilt table evaluation","description":"Evaluation of cardiovascular function with tilt table evaluation, with continuous ecg monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":151.6,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0626","name":"Lo sag rig pnl stays pre cst","description":"Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabrica","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38100","name":"Removal of spleen total","description":"Splenectomy; total (separate procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99497","name":"Advncd care plan 30 min","description":"Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surroga","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27286","name":"Arthrd hip jt sbtrchc osteot","description":"Arthrodesis, hip joint (including obtaining graft); with subtrochanteric osteotomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1399.22,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"78271","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":60.18,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87475","name":"Lyme dis dna dir probe","description":"Infectious agent detection by nucleic acid (dna or rna); borrelia burgdorferi, direct probe technique","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"74185","name":"Mra abd w or w/o cntrst","description":"Magnetic resonance angiography, abdomen, with or without contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15275","name":"Skin sub graft face/nk/hf/g","description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"31651","name":"Bronchial valve addl insert","description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure[s])","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"47536","name":"Exchange biliary drg cath","description":"Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A9505","name":"Tl201 thallium","description":"Thallium tl-201 thallous chloride, diagnostic, per millicurie","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":29.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54057","name":"Laser surg penis lesion(s)","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"15300","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"K0855","name":"Pwc gp 3 xhd cap chair","description":"Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","UE","93","NU","RR",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70460","name":"Ct head/brain w/dye","description":"Computed tomography, head or brain; with contrast material(s)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","26","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92960","name":"Cardioversion electric ext","description":"Cardioversion, elective, electrical conversion of arrhythmia; external","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":152.81,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"20555","name":"Place ndl musc/tis for rt","description":"Placement of needles or catheters into muscle and/or soft tissue for subsequent interstitial radioelement application (at the time of or subsequent to the procedure)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":265.08,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"44146","name":"Partial removal of colon","description":"Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1726.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"63190","name":"Incise spine nrv >2 segmnts","description":"Laminectomy with rhizotomy; more than 2 segments","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"00192","name":"Anes px fcl b1/skl rad surg","description":"Anesthesia for procedures on facial bones or skull; radical surgery (including prognathism)","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80186","name":"Assay of phenytoin free","description":"Phenytoin; free","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.65,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82979","name":"Assay rbc glutathione","description":"Glutathione reductase, rbc","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"27594","name":"Amputation follow-up surgery","description":"Amputation, thigh, through femur, any level; secondary closure or scar revision","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":437.86,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"43800","name":"Pyloroplasty","description":"Pyloroplasty","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L0635","name":"Lso sagit rigid panel prefab","description":"Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pr","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99490","name":"Chrnc care mgmt staff 1st 20","description":"Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or funct","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86904","name":"Blood typing patient serum","description":"Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"93788","name":"Ambl bp mntr w/sw a/r","description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; scanning analysis with report","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93","TC"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L1650","name":"Ho abduction hip adjustable","description":"Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":108.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"L3960","name":"Sewho airplan desig abdu pos","description":"Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","rural":"N","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99184","name":"Hypothermia ill neonate","description":"Initiation of selective head or total body hypothermia in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude eeg, supervision of controlled hypothermia, ","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"28510","name":"Treatment of toe fracture","description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"L3701","name":"UNK","description":"UNK","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":9.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"50325","name":"Prep donor renal graft","description":"Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"51050","name":"Removal of bladder stone","description":"Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":381.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"38211","name":"Tumor cell deplete of harvst","description":"Transplant preparation of hematopoietic progenitor cells; tumor cell depletion","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"21116","name":"Injection jaw joint x-ray","description":"Injection procedure for temporomandibular joint arthrography","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":159.37,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"24100","name":"Arthrt elbw synovial bx only","description":"Arthrotomy, elbow; with synovial biopsy only","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"49550","name":"Rpr rem hernia init reduce","description":"Repair initial femoral hernia, any age; reducible","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42","45"]},{"name":"DateOfServiceGreaterThanOrEqualTo","value":["4/1/2025"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP","MCRPPO"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":20.0,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","21","02","65","81","24","22"],"billing_code_modifier":["GT","GQ","95","93","NU",""]}],"provider_references":[1]}]},{"negotiation_arrangement":"ffs","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"46712","name":"Repr per/vag pouch dbl proc","description":"Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; combined transperineal and transabdominal approach","date_of_service":"2026-05-05","locality":"1320202","zip":"00501","other_properties":[{"name":"Company Code","value":["01","02","20","42"]},{"name":"ProductId","value":["CHPHMO","EPHMO","MEDICAIDHMO","QHPHMO","SHP"]}],"negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":1867.9,"expiration_date":"9999-12-31","billing_class":"professional","setting":"both","service_code":["13","23","12","21","02","65","11","24","22","10"],"billing_code_modifier":["GT","GQ","95","93"]}],"provider_references":[1]}]}]}
